G. Joseph et al., MECHANISMS OF CARDIAC PERFORATION LEADING TO TAMPONADE IN BALLOON MITRAL VALVULOPLASTY, Catheterization and cardiovascular diagnosis, 42(2), 1997, pp. 138-146
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.