Percutaneous closure of left ventricular pseudoaneurysm. Case resolution

Abstract

CASE RESOLUTION The case was presented in the medical-surgical session and given the high risk involved the percutaneous closure of the pseudoaneurysm was decided.1-2 The procedure was performed under general anesthesia and guided by transesophageal echocardiography and fluoroscopic fusion imaging. Since the patient carried a prosthetic mitral valve, a retrograde approach strategy was decided via right femoral arterial access (6-Fr). With help from an AL 1 catheter (Cordis Corporation, FL, United States) and a Terumo straight guidewire (Terumo Medical Corporation, NJ, United States), the native aortic valve was crossed, and the AL 1 catheter was advanced towards the left ventricle. A Pigtail catheter was used to perform a left ventriculography (Cordis Corporation, FL, United States) that revealed a cavity in relation to the left ventricle with the passing of contrast towards such cavity (video 1 of the supplementary data). After several attempts trying to place the catheter at the origin of the defect, the pseudoaneurysm cavity was finally crossed using a curved Terumo guidewire. At this point, the information provided by fluoroscopic fusion imaging was crucial because it revealed the origin of the defect and facilitated guidewire crossing towards the cavity (figure 1 and figure 2). Figure 1. Location of the origin of pseudoaneurysm through...