Retrograde catheterization of left ventricle through mechanical aortic prostheses

Rigaud, M.; Dubourg, Olivier; Luwaert, R.; Rocha, P; Hamoir, V.; Bardet, J; Bourdarias, J. P.

doi:10.1093/eurheartj/8.7.689

Cited by 22 publications

(13 citation statements)

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“…9 The risks of catheter entrapment, hypotension, life-threatening valvular insufficiency, and death have shown that crossing these valves is undesirable. 1, 2, 10, 11 Coronary pressure sensing wires have been used for invasive hemodynamic evaluation and measurement of bileaflet mechanical valve gradients. 12 However, these techniques are not suitable when larger catheters are needed to be introduced into the LV.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Vaseghi¹,

Macias²,

Tung³

et al. 2013

Heart Rhythm

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IntroductionCatheter ablation of ventricular tachycardia (VT) is typically performed using either the atrial transseptal approach or a retrograde aortic approach in order to gain access to the left ventricle (LV). However, neither approach is feasible in the setting of mechanical aortic and mitral valve replacements, given the risk of catheter entrapment and death. 1, 2 Therefore, approaches that avoid traversing these valves, such as a percutaneous trans-apical approach, have been developed. [3][4][5][6] However, the trans-apical approach is associated with a significant rate of access related complications, particularly bleeding at the puncture site, and necessitates the placement of closure devices in the LV. 7,8 We describe a novel percutaneous inter-ventricular transseptal puncture technique and placement of a sheath across the inter-ventricular septum for catheter ablation of VT. This method allowed for stable LV access and spontaneous closure of the septal access site. Case Report Clinical HistoryA 35-year-old male was referred to our center for catheter ablation of recurrent VT requiring multiple implantable cardiac defibrillator (ICD) therapies. He had undergone mechanical aortic and mitral valve replacements after developing endocarditis due to a dental abscess. Five years later, he suffered from sudden cardiac arrest and a single-lead ICD was placed. His ejection fraction was estimated at 35% and Q waves were noted on the ECG in the inferior leads. He subsequently suffered from VT storm with increasing number of ICD shocks and anti-tachycardia pace terminated (ATP) episodes despite therapy with sotalol and © 2013 The Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.Address for correspondence: Kalyanam Shivkumar, M.D., Ph.D., FHRS, UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite # 660, Los Angeles, CA 90095, 310-206-2235 (phone), 310-825 4251 (Fax), kshivkumar@mednet.ucla.edu. Disclosure: The Regents of the University of California, Los Angeles has intellectual property developed by the author (KS) that relate to data reported in this paper.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. amiodarone, and also developed trans-aminitis secondary to amiodarone. In the past year, he had suffered from 110 episodes of VT requiring either ATP or ICD shocks and was highly symptomatic, even during the ATP episodes. Given the presence of mechanical prostheses in the mitral and aortic valve positions, a novel method of LV access across the interventricular septum was discussed wi...

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Section: Discussionmentioning

confidence: 99%

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Vaseghi¹,

Macias²,

Tung³

et al. 2013

Heart Rhythm

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show abstract

“…The major limitation of this technique was the inability to perform conventional left ventricular angiography through the probing catheter due to the size. Rigaud et al [15] reported the hemodynamic measurements performed with retrograde left ventricular catheterization compared to transseptal or transapical left ventricular catheterization in 23 patients with Starr-Edwards or Bjork-Shiley prosthesis. They reported interference with the diastolic closure mechanism of the valve with resultant aortic regurgitation and approximately a 50% increase in the gradient across the aortic valve with retrograde left ventricular catheterization.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular apical puncture: A procedure surviving well into the new millennium

Turgut

Deeb

Moscucci

2000

Cathet. Cardiovasc. Intervent.

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“…The latter may affect transvalvular flow patterns to such a degree that valvular insufficiency is introduced, or valvular stenosis may be exaggerated. Other types of mechanical prosthetic valves can be crossed safely in some individuals, but the risk of embolic dislodgment remains [19,20]. In general, bioprosthetic valves can be easily and safely crossed during catheterization.…”

Section: Catheters and Prosthetic Valvesmentioning

confidence: 99%

Transthoracic cardiac ventriculostomy beyond y2K: Barbarism or modern medicine?

Eisenhauer¹,

Kern²

2000

Cathet. Cardiovasc. Intervent.

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Retrograde catheterization of left ventricle through mechanical aortic prostheses

Cited by 22 publications

References 0 publications

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

Left ventricular apical puncture: A procedure surviving well into the new millennium

Transthoracic cardiac ventriculostomy beyond y2K: Barbarism or modern medicine?

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