MECHANISMS OF CARDIAC PERFORATION LEADING TO TAMPONADE IN BALLOON MITRAL VALVULOPLASTY

Mechanisms of cardiac perforation in 10 cases of cardiac tamponade enc ountered in a single-center series of 903 balloon mitral valvuloplasty procedures were elucidated by precise localization of the site of per foration at subsequent surgery. These mechanisms were perforation of t he aortic root and adjacent right atrium by sliding up of the transsep tal set (2), apical tears by straight-tip balloon catheters driven dis tally during mitral valve dilatation (3), apical perforations by guide wires introduced through catheters wedged in the apex (2), tear of the posterior right atrial wall by dilatation of the track produced by ve ry low septal punctures (2), and right ventricular perforation by a pa cing catheter (1), Multivariate analysis showed cardiac perforation to be significantly related to the total experience at the center (inver sely) and to patient age (directly), Left ventricular perforation occu rred exclusively in patients >40 yr of age, Understanding these mechan isms has enabled formulation of effective strategies to prevent cardia c perforation. (C) 1997 Wiley-Liss, Inc.