Percutaneous left ventricular transapical access guided by cardiac 3D CT angiography combined with echocardiography_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Jie , RUAN Weiqiang , GAN Changping ,  DIAN Ke

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

DIAN Ke, Email: edwrddian@hotmail.com

Keywords：

Cardiac 3D-CT angiography; percutaneous transapical access; structural heart defects

DOI：

10.7507/1007-4848.201903060

Video：

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Objective To investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects.Methods The clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE).Results The puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury.Conclusion That cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.

Citation： WANG Jie, RUAN Weiqiang, GAN Changping, DIAN Ke. Percutaneous left ventricular transapical access guided by cardiac 3D CT angiography combined with echocardiography. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 704-707. doi: 10.7507/1007-4848.201903060 Copy

1.	Brock R, Milstein BB, Ross DN. Percutaneous left ventricular puncture in the assessment of aortic stenosis. Thorax, 1956, 11(3): 163-171.
2.	Dudiy Y, Kliger C, Jelnin V, et al. Percutaneous transapical access: current status. EuroIntervention, 2014, 10(Suppl U): U84-U89.
3.	Kliger C, Jelnin V, Sharma S, et al. CT angiography-fluoroscopy fusion imaging for percutaneous transapical access. JACC Cardiovasc Imaging, 2014, 7(2): 169-177.
4.	Karimov JH, Mihaljevic T, Gao S, et al. New cardioscope-based platform for minimally invasive and percutaneous beating heart interventions. Semin Thorac Cardiovasc Surg, 2019, 31(2): 209-215.
5.	Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: a preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
6.	Braunwald. Cooperative study on cardiac catheterization. Circulation, 1968, 37(5 Suppl): Ⅲ80.
7.	Havranek EP, Sherry PD. Left heart catheterization by direct puncture with two-dimensional echocardiographic guidance: a case report. Cathet Cardiovasc Diagn, 1995, 35(4): 358-361.
8.	Pitta SR, Cabalka AK, Rihal CS. Complications associated with left ventricular puncture. Catheter Cardiovasc Interv, 2010, 76(7): 993-997.
9.	Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol, 2011, 58(21): 2210-2217.
10.	Jelnin V, Dudiy Y, Einhorn BN, et al. Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit. JACC Cardiovasc Interv, 2011, 4(8): 868-874.
11.	Tabata M. Transapical approach in transcatheter cardiovascular interventions. Gen Thorac Cardiovasc Surg, 2018, 66(4): 185-191.
12.	Aydin U, Sen O, Kadirogullari E, et al. Surgical transapical approach for prosthetic mitral paravalvular leak closure: early results. Artif Organs, 2017, 41(3): 253-261.

1. Brock R, Milstein BB, Ross DN. Percutaneous left ventricular puncture in the assessment of aortic stenosis. Thorax, 1956, 11(3): 163-171.
2. Dudiy Y, Kliger C, Jelnin V, et al. Percutaneous transapical access: current status. EuroIntervention, 2014, 10(Suppl U): U84-U89.
3. Kliger C, Jelnin V, Sharma S, et al. CT angiography-fluoroscopy fusion imaging for percutaneous transapical access. JACC Cardiovasc Imaging, 2014, 7(2): 169-177.
4. Karimov JH, Mihaljevic T, Gao S, et al. New cardioscope-based platform for minimally invasive and percutaneous beating heart interventions. Semin Thorac Cardiovasc Surg, 2019, 31(2): 209-215.
5. Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: a preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
6. Braunwald. Cooperative study on cardiac catheterization. Circulation, 1968, 37(5 Suppl): Ⅲ80.
7. Havranek EP, Sherry PD. Left heart catheterization by direct puncture with two-dimensional echocardiographic guidance: a case report. Cathet Cardiovasc Diagn, 1995, 35(4): 358-361.
8. Pitta SR, Cabalka AK, Rihal CS. Complications associated with left ventricular puncture. Catheter Cardiovasc Interv, 2010, 76(7): 993-997.
9. Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol, 2011, 58(21): 2210-2217.
10. Jelnin V, Dudiy Y, Einhorn BN, et al. Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit. JACC Cardiovasc Interv, 2011, 4(8): 868-874.
11. Tabata M. Transapical approach in transcatheter cardiovascular interventions. Gen Thorac Cardiovasc Surg, 2018, 66(4): 185-191.
12. Aydin U, Sen O, Kadirogullari E, et al. Surgical transapical approach for prosthetic mitral paravalvular leak closure: early results. Artif Organs, 2017, 41(3): 253-261.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Percutaneous left ventricular transapical access guided by cardiac 3D CT angiography combined with echocardiography

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