Safety and clinical benefits of transsubxiphoidal left ventricular puncture

Abstract

We performed a transsubxiphoidal LV puncture (TSLVP) to evaluate left ventricular function in 21 patients with both mechanical prosthetic aortic and mitral valves and successfully obtained hemodynamic information on each patient. Analyzing cardiac hemodynamic information and ventriculographic findings obtained with TSLVP, we concluded that seven of the patients required repair of their prosthetic valves. Five of these seven patients agreed to replacement of their valves, whereas two did not. TSLVP was performed adequately and safely without severe complications, suggesting that this maneuver is easier than that of transapical LV puncture and should be recommended for the assessment of left ventricular hemodynamic functions instead of the transapical LV puncture, especially in patients requiring replacement of two valves.

Percutaneous treatment of aortic valve stenosis

“…[31][32][33] Potential disadvantages are related to the left ventricu-lar apical puncture and include adverse ventricular remodeling, left ventricular aneurysm or pseudoaneurysm, pericardial complications, pneumothorax, malignant ventricular arrhythmias, coronary artery injury, and the need for general anesthesia and chest tubes. 27,[31][32][33][34][35] common features of the three approaches The three percutaneous approaches have certain final steps in common. 11,23,30,33 The position of final deployment of the prosthetic valve is determined by the patient's native valvular structure and anatomy and is optimized by using fluoroscopic imaging of the native aortic valve calcification as an anatomical marker, along with guidance from supra-aortic angiography and transesophageal echocardiography.…”