Lots of interesting abstracts and cases were submitted for TCTAP 2021 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don’t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
TCTAP C-088
Presenter
Hsu chung Lo
Authors
Tsun-Jui Liu1, Hsu Chung Lo1, Chih Hung Lai1
Affiliation
Taichung Veterans General Hospital, Taiwan1,
View Study Report
TCTAP C-088
ENDOVASCULAR - Complications
Closure of an Iatrogenic RVOT Injury by Amplatzer Vascular Plug
Tsun-Jui Liu1, Hsu Chung Lo1, Chih Hung Lai1
Taichung Veterans General Hospital, Taiwan1,
Clinical Information
Patient initials or Identifier Number
000922914F
Relevant Clinical History and Physical Exam
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.
Relevant Test Results Prior to Catheterization
A computed tomography of chest was done later and showed consolidation of left lower lung
and pericardial effusion with small size of Right Ventricle chamber.
and pericardial effusion with small size of Right Ventricle chamber.
20201106_143417.mp4Relevant Catheterization Findings
The study by fluoroscopic at cardiac catheterization room suspected pigtail catheter might be misplaced into right ventricle
000922914F_001.AVI
000922914F_019.AVI
000922914F_020.AVI
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.AVIInterventional Management
Procedural Step
At the beginning, a new pigtail was inserted into pericardial space successfully through subxiphoid approach under fluoroscopic guidance.The Intra-cardiac pigtail was removed over a 0.035 Terumo Super Stitch wire and followed by a 6 French sheath insertion. We first deployed distal disc and pull this device back tightly to make sure the distal disc contact well to the vessel wall. After that, we deployed second disc and closured right ventricle perforation by 6mm amplatzer vascular plug successfully.
000922914F_014.AVI
000922914F_023.AVI
000922914F_042.AVI
000922914F_014.AVI 000922914F_023.AVI 000922914F_042.AVICase Summary
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.