ENDOVASCULAR - Complications
Closure of an Iatrogenic RVOT Injury by Amplatzer Vascular Plug
Tsun-Jui Liu1, Hsu chung Lo1, Chin Hung Lai1
Taichung Veterans General Hospital, Taiwan1,
An 89- years old female with history of diabetes mellitus, hypertension presented to our emergency department with symptoms of severe dyspnea for three days. At presentation, shock status was also noted. The chest radiography revealed enlarged pericardial shadow and blunting of left costophrenic angle. A Computed tomography of chest was done later and showed consolidation of left lower lung and pericardial effusion. Bedside echocardiography (ECHO) revealed pericardial effusion with right ventricle compression and pending cardiac tamponade was highly suspected. Due to this critical condition, pericardiocentesis was performed by para-sternal approach and a pigtail catheter was inserted. However, malposition of the drainage pigtail catheter was suspected immediately when aspirate showed frank blood and lower blood pressure developed. The repeat ECHO showed the pigtail catheter might be misplaced into right ventricle. Fluid challenge and blood transfusion were given and emergent consult of cardiovascular surgeon for open surgery was done. However, due to advanced age and poor general condition, high surgical risk of open surgery was informed. After discussing with the patient, a decision was taken to percutaneous close the perforation.
The study by fluoroscopic at cardiac catheterization room suspected pigtail catheter might be misplaced into right ventricle
A contrast injection through the old pig-tail revealed pulmonary trunk, thus confirming its position in the right ventricle outflow tract. 000922914F_001.AVI 000922914F_019.AVI 000922914F_020.AVI
Pericardiocentesis with pericardial drainage could be a lifesaving and relatively safe procedure. Nevertheless, complications are not rare and can sometimesbe difficult to handle, such as cardiac perforation. Percutaneousdevice closure is a feasible approach forinadvertent perforation of RV duringpericardiocentesis and should be consideredas an alternative to open surgery.