Author + information
- S1936879815021998-92f04216fc0210f3577ce0b50753190aAshish H. Shah1,
- S1936879815021998-580ec63e551b73ba6af6a2984817b38dDivyesh Sharma1,
- S1936879815021998-26361e7df73a4016adcfcfffc2622544Jagdish Butany2,
- S1936879815021998-20236bcc09fb8fb4455cfb2874ec820cRobert J. Cusimano1,
- S1936879815021998-c4499554e57a881f9134c8f15a186e0eEric Horlick1,
- S1936879815021998-0180c14ddd73d2c445d22c451c28840fKatrijn Jansen1,
- S1936879815021998-a39b4068fe8e8fcca38ddf3d4af046adAlan Barolet1,
- S1936879815021998-9024ddb05c44d5862e49fbc5a60e8d84Mark Osten1,
- S1936879815021998-0097508af95d540f2820470dbe061b97Vladimir Dzavik1 and
- S1936879815021998-aed152d891b25db500c1fdbf81a5cdc3Peter Seidelin1
Pericardial effusion is mainly caused by infection, inflammation or malignancy. Rapid or excessive fluid collection can restrict cardiac filling, resulting in hemodynamic compromise. Percutaneous pericardiocentesis is performed in majority of such patients. One of the dreaded complications during this procedure is the inadvertent insertion of drain into the right ventricular cavity. The currently available treatment for this complication is surgical removal of the drain after thoracotomy, and a purse string suture around the drain site or a patch closure. Open-heart surgery is associated with inherent morbidity and mortality. Isolated case reports have demonstrated feasibility of using an AngioSeal® or vascular plugs to close such defect.
Perclose® suture mediated closure system is commonly used to close large caliber sheath entry sites into the arteries and veins after percutaneous structural interventions. We sought to assess the feasibility and efficacy of Perclose to close the drain entry site into the right ventricle. The local Research and Ethics Board granted approval for this study. We used a pericardial drain set to intentionally enter the 10 Fr sheath (pericardial drain is an 8.3 Fr system) into the ventricular cavity, when the heart was in situ. The sheath was then taken out over the wire and Perclose system was introduced to deploy a suture in a standard fashion. Effectiveness of the deployed suture in closing the defect was assessed after the heart was explanted. Perclose deployed a suture, and effectively closed the sheath entry site into the right ventricle in each of the experiments (n=4), as shown in the image 1B.
Perclose suture delivering system (can be used as) may be an alternative non-operative option to close such a defect caused by inadvertent insertion of the pericardial drain in right ventricular cavity. Further study is warranted.