PMC9576871_01
Treatment for iatrogenic right ventricular perforation. (A) Delivery system carrying the MLP to right ventricle. (B) Medium-volume effusion in the pericardial cavity. (C) 12F pigtail catheter placed (under ultrasound guidance) into the pericardial cavity. (D) CEUS shows right ventricular free wall perforation (with arrow indication). (E) 3-0 prolene with spacers were used to close the RV perforation. (F) Recovery of cardiac function after surgery. RV, right ventricle; LV, left ventricle; PE, pericardial effusion.
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F1
The patient's right femoral vein was punctured and fed with a stiffened guidewire, while the transfer sheath and delivery system carrying the Micra were delivered into the middle of the right atrium successively, then the delivery system bent across the tricuspid valve to the right ventricular septum (Figure 1A). A medium dose of pericardial fluid and heart compression (Figure 1B) were identified with a Mindray M8 portable color Doppler ultrasound diagnostic instrument and a C5-1 probe (frequency: 2-5 MHz). For emergency treatment, a 12F pigtail catheter (Lingjie, Guangzhou, China) was inserted, with the guidance of ultrasound, to drain the pericardial effusion (Figure 1C). Eight seconds later, microsphere contrast agent spilled into pericardial cavity through right ventricular free wall and concentrated locally (Figure 1D; Supplementary Video 1). Five stitches of 3-0 prolene with spacers were used to intermittently close the perforation (Figure 1E; Supplementary Video 2). Two days after the surgery, transthoracic echocardiography results showed that the patient's cardiac function was restored, with left ventricular ejection fraction at 50% (Figure 1F).