Successful percutaneous closure of an iatrogenic right ventricular perforation utilizing an Angio-Seal device: a case report.

Abstract

Background: Pericardiocentesis, a procedure with potential life-saving implications, can lead to complications such as cardiac perforation. Emergency open cardiac surgery, the conventional approach for addressing iatrogenic or traumatic cardiac perforations, is associated with unfavourable outcomes in high-risk patients. This report explores a case of accidental iatrogenic right ventricular (RV) puncture, which was effectively managed using a percutaneous closure device.

Case summary: A 42-year-old male was hospitalized due to a persistent cough, dyspnoea, and fever, raising suspicion of tuberculosis. He was found to have a large pericardial effusion with signs of impending cardiac tamponade. During an attempted pericardiocentesis at an outside facility, his right ventricle was inadvertently perforated by a catheter. He was transferred to a specialized hospital to be assessed by a cardiac surgeon, where the heart team performed a percutaneous closure of the perforation using an Angio-Seal device, which was successful. A subsequent pericardiectomy was performed to address the effusion and confirm the absence of tuberculosis or malignancy. The patient recovered well, and follow-up imaging showed no worsening of the pericardial effusion. He was discharged in stable condition.

Discussion: Pericardiocentesis, while crucial for treating large pericardial effusions, carries a small risk of complications such as ventricular perforation. Although surgery is a cornerstone in management, the Angio-Seal device has been used successfully in some cases to repair these tears. In this case, an Angio-Seal device effectively closed a RV rupture, with no further complication seen in follow-up exams. This suggests Angio-Seal as a potentially useful, less invasive option for treating such complications.