Author + information
- Received November 20, 2011
- Revision received December 13, 2011
- Accepted December 22, 2011
- Published online April 1, 2012.
- ↵⁎Reprint requests and correspondence:
Dr. Muhammad Munawar, Binawaluya Cardiac Center, TB Simatupang Street 71, East of Jakarta, Jakarta City, Indonesia 13750
An octogenarian man with severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy. The procedure was complicated by accidental unrecognized aortic root puncture by Brockenbrough needle followed by the delivery of the 8-F Mullin sheath (Medtronic, Minneapolis, Minnesota). Subsequent contrast injection demonstrated the left coronary artery (Fig. 1A). The complication could be avoided if some cautious procedure were performed, such as measuring the pressure from the Brockenbrough needle to differentiate the left atrial and aortic pressure before advancing the Mullin sheath (Medtronic). We decided to seal the hole with a 4-mm Amplatzer Septal Occluder (ASO) device (St. Jude Medical, St. Paul, Minnesota) instead of surgical intervention. A coiled guidewire (arrow) was advanced to the aorta to facilitate the exchange of the Mullin sheath with an 8-F ASO delivery sheath (Fig. 1B). A test injection of contrast medium confirmed position within aortic root. The loader with the collapsed device was then advanced into the delivery catheter by pushing the delivery cable. Under fluoroscopic and ultrasonic guidance, the ASO device (arrow) was deployed the left atrial disk and pulled gently against the aortic wall, which was both felt and observed by 2-dimensional echocardiography (Fig. 1C). Using gentle tension on the delivery cable, the sheath (arrowhead) was pulled back and the right atrial disk was deployed. Echocardiography and contrast fluoroscopy confirmed optimal position across the communication and the position of the right coronary artery. After release of the ASO (Fig. 1D), both color Doppler echocardiography and angiography performed showed the absence of the residual shunt. During 6-month echocardiographic follow-up, the ASO device remained in place without any residual flow observed. This is the first usage of such a device for a complication that always requires an open-heart surgery (Online Video).
For an accompanying video, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 20, 2011.
- Revision received December 13, 2011.
- Accepted December 22, 2011.
- American College of Cardiology Foundation