Premium
Percutaneous occlusion of transseptal puncture‐related free wall perforation at the coronary sinus with a ventricular septal occluder during left atrial appendage closure: A case report
Author(s) -
Bai Yuan,
Zhang Sha,
Qin Yongwen,
Zhao Xianxian
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28589
Subject(s) - medicine , coronary sinus , perforation , tamponade , percutaneous , fluoroscopy , cardiac tamponade , surgery , cardiology , ostium , atrial fibrillation , materials science , punching , metallurgy
Coronary sinus perforation is a life‐threatening complication of transseptal puncture and needs to be repaired immediately. In this study, we report a case of a 74‐year‐old female patient with nonvalvular atrial fibrillation, who is a poor long‐term anticoagulation candidate. During the manipulation of transseptal puncture, a perforation of the free right atrial wall at the coronary sinus ostium occurred, which was caused by the Brockenbrough needle and followed by the immediate advancement of an 8.5‐French transseptal sheath. In consideration of the danger of cardiac tamponade after sheath removal, we decided to leave the 8.5‐French sheath in the pericardial cavity. Then, we advanced a 6 mm ventricular septal occluder through the sheath. Finally, we achieved successful deployment of the device and closure of the perforation under the guidance of fluoroscopy and transthoracic echocardiography. Subsequently, the left atrial appendage orifice was occluded with a 21 mm Watchman device. This case illustrates that percutaneous device closure is feasible for inadvertent perforation of the free right atrial wall at the coronary sinus during transseptal puncture and should be considered as an alternative to surgery.