Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology
Aims Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root pu...
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Veröffentlicht in: | Europace (London, England) England), 2019-07, Vol.21 (7), p.1106-1115 |
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creator | Chen, Hao Fink, Thomas Zhan, Xianzhang Chen, Minglong Eckardt, Lars Long, Deyong Ma, Jian Rosso, Raphael Mathew, Shibu Xue, Yumei Ju, Weizu Wasmer, Kristina Ma, Changsheng Yang, Jiandu Maurer, Tilman Yang, Bing Heeger, Christian-Hendrik Ho, Siew Yen Kuck, Karl-Heinz Wu, Shulin Ouyang, Feifan |
description | Aims
Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP.
Methods and results
All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure.
Conclusion
Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair. |
doi_str_mv | 10.1093/europace/euz042 |
format | Article |
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Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP.
Methods and results
All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure.
Conclusion
Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euz042</identifier><identifier>PMID: 30887036</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>Europace (London, England), 2019-07, Vol.21 (7), p.1106-1115</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c332t-af396e771c2e9e607f0dd4eb8cda7b2b76bb7032e95d6ec0ad73e596b82d82f73</citedby><cites>FETCH-LOGICAL-c332t-af396e771c2e9e607f0dd4eb8cda7b2b76bb7032e95d6ec0ad73e596b82d82f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1604,27924,27925</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euz042$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30887036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Hao</creatorcontrib><creatorcontrib>Fink, Thomas</creatorcontrib><creatorcontrib>Zhan, Xianzhang</creatorcontrib><creatorcontrib>Chen, Minglong</creatorcontrib><creatorcontrib>Eckardt, Lars</creatorcontrib><creatorcontrib>Long, Deyong</creatorcontrib><creatorcontrib>Ma, Jian</creatorcontrib><creatorcontrib>Rosso, Raphael</creatorcontrib><creatorcontrib>Mathew, Shibu</creatorcontrib><creatorcontrib>Xue, Yumei</creatorcontrib><creatorcontrib>Ju, Weizu</creatorcontrib><creatorcontrib>Wasmer, Kristina</creatorcontrib><creatorcontrib>Ma, Changsheng</creatorcontrib><creatorcontrib>Yang, Jiandu</creatorcontrib><creatorcontrib>Maurer, Tilman</creatorcontrib><creatorcontrib>Yang, Bing</creatorcontrib><creatorcontrib>Heeger, Christian-Hendrik</creatorcontrib><creatorcontrib>Ho, Siew Yen</creatorcontrib><creatorcontrib>Kuck, Karl-Heinz</creatorcontrib><creatorcontrib>Wu, Shulin</creatorcontrib><creatorcontrib>Ouyang, Feifan</creatorcontrib><title>Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Aims
Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP.
Methods and results
All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure.
Conclusion
Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.</description><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqFkM9PwyAUx4nRuDk9ezMcjUmVwlqKN7P4K1niRc8NhVetdlCBbpkn_3SZ3bx64gU-7_N4X4ROU3KZEsGuoHe2kwpi8UWmdA-N04zRhBJB92NNhEiylIoROvL-nRDCqcgO0YiRouCE5WP0_WikXoILYAIOThrvoQuyxV1vVOgd4MYEi8MbYGldaBR21obr3wsjnbMrDPoVcAVhBWBw26sPLI3GSgbpQ_zd20axsYBbxiGNNdGupNONbe3r-hgd1LL1cLI9J-jl7vZ59pDMn-4fZzfzRDFGQyJrJnLgPFUUBOSE10TrKVSF0pJXtOJ5VcWN4mOmc1BEas4gE3lVUF3QmrMJOh-8nbOfPfhQLhqvoG2lAdv7kqZimk5zwVlErwZUOeu9g7rsXLOQbl2mpNzEXu5iL4fYY8fZVt5XC9B__C7nCFwMgO27f20_bhCUIA</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Chen, Hao</creator><creator>Fink, Thomas</creator><creator>Zhan, Xianzhang</creator><creator>Chen, Minglong</creator><creator>Eckardt, Lars</creator><creator>Long, Deyong</creator><creator>Ma, Jian</creator><creator>Rosso, Raphael</creator><creator>Mathew, Shibu</creator><creator>Xue, Yumei</creator><creator>Ju, Weizu</creator><creator>Wasmer, Kristina</creator><creator>Ma, Changsheng</creator><creator>Yang, Jiandu</creator><creator>Maurer, Tilman</creator><creator>Yang, Bing</creator><creator>Heeger, Christian-Hendrik</creator><creator>Ho, Siew Yen</creator><creator>Kuck, Karl-Heinz</creator><creator>Wu, Shulin</creator><creator>Ouyang, Feifan</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190701</creationdate><title>Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology</title><author>Chen, Hao ; Fink, Thomas ; Zhan, Xianzhang ; Chen, Minglong ; Eckardt, Lars ; Long, Deyong ; Ma, Jian ; Rosso, Raphael ; Mathew, Shibu ; Xue, Yumei ; Ju, Weizu ; Wasmer, Kristina ; Ma, Changsheng ; Yang, Jiandu ; Maurer, Tilman ; Yang, Bing ; Heeger, Christian-Hendrik ; Ho, Siew Yen ; Kuck, Karl-Heinz ; Wu, Shulin ; Ouyang, Feifan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c332t-af396e771c2e9e607f0dd4eb8cda7b2b76bb7032e95d6ec0ad73e596b82d82f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Hao</creatorcontrib><creatorcontrib>Fink, Thomas</creatorcontrib><creatorcontrib>Zhan, Xianzhang</creatorcontrib><creatorcontrib>Chen, Minglong</creatorcontrib><creatorcontrib>Eckardt, Lars</creatorcontrib><creatorcontrib>Long, Deyong</creatorcontrib><creatorcontrib>Ma, Jian</creatorcontrib><creatorcontrib>Rosso, Raphael</creatorcontrib><creatorcontrib>Mathew, Shibu</creatorcontrib><creatorcontrib>Xue, Yumei</creatorcontrib><creatorcontrib>Ju, Weizu</creatorcontrib><creatorcontrib>Wasmer, Kristina</creatorcontrib><creatorcontrib>Ma, Changsheng</creatorcontrib><creatorcontrib>Yang, Jiandu</creatorcontrib><creatorcontrib>Maurer, Tilman</creatorcontrib><creatorcontrib>Yang, Bing</creatorcontrib><creatorcontrib>Heeger, Christian-Hendrik</creatorcontrib><creatorcontrib>Ho, Siew Yen</creatorcontrib><creatorcontrib>Kuck, Karl-Heinz</creatorcontrib><creatorcontrib>Wu, Shulin</creatorcontrib><creatorcontrib>Ouyang, Feifan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Chen, Hao</au><au>Fink, Thomas</au><au>Zhan, Xianzhang</au><au>Chen, Minglong</au><au>Eckardt, Lars</au><au>Long, Deyong</au><au>Ma, Jian</au><au>Rosso, Raphael</au><au>Mathew, Shibu</au><au>Xue, Yumei</au><au>Ju, Weizu</au><au>Wasmer, Kristina</au><au>Ma, Changsheng</au><au>Yang, Jiandu</au><au>Maurer, Tilman</au><au>Yang, Bing</au><au>Heeger, Christian-Hendrik</au><au>Ho, Siew Yen</au><au>Kuck, Karl-Heinz</au><au>Wu, Shulin</au><au>Ouyang, Feifan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>21</volume><issue>7</issue><spage>1106</spage><epage>1115</epage><pages>1106-1115</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Aims
Inadvertent puncture of the aortic root (AR) is a well-known complication of transseptal puncture (TSP). Strategies for handling of this potentially lethal complication have not been identified yet. In this study, we present typical anatomical locations and clinical management of aortic root puncture (ARP) due to TSP.
Methods and results
All patients with ARP were retrospectively collected from seven hospitals. Aortic root puncture was identified and classified regarding angiographical and intraoperative findings in cardiac surgery: (i) TSP from the right atrium (RA) to the non-coronary sinus (NCS), (ii) TSP from RA to the non-coronary sinutubular junction (STJ), and (iii) TSP from RA to the ascending aorta (AA). A total of 24 patients with inadvertent ARP were identified. In 19 patients, penetration of the aorta was accomplished by the inner dilator, in 5 patients by the complete sheath. Previous cardiac surgery had been performed in six patients. There were 13 RA-to-NCS punctures, 2 RA-to-STJ punctures, and 9 RA-to-AA punctures. No cardiac tamponade (CT) occurred in patients with RA-to-NCS and RA-to-STJ punctures. In 8 of 9 patients with RA-to-AA puncture, CT occurred immediately requiring urgent pericardiocentesis and surgical repair. Two patients died after surgical repair. In the 16 patients without surgical therapy, no shunt from the AR to the RA was observed 3 months after the procedure.
Conclusion
Aortic root puncture due to mislead TSP via NCS or STJ is usually not associated with a severe clinical course while ARP into the AA via the epicardial space generally leads to CT requiring surgical repair.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30887036</pmid><doi>10.1093/europace/euz042</doi><tpages>10</tpages></addata></record> |
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title | Inadvertent transseptal puncture into the aortic root: the narrow edge between luck and catastrophe in interventional cardiology |
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