title: Percutaneous transthoracic ventricular puncture for diagnostic and interventional catheterization.
abstract: OBJECTIVE
  To describe our experience in a case series of patients requiring percutaneous direct ventricular puncture and sheath placement for diagnosis or intervention.
  
  
  BACKGROUND
  Access to the right or left ventricle for percutaneous interventions is limited in patients with mechanical prostheses in either the tricuspid, or mitral and aortic positions.
  
  
  METHODS
  After coronary angiography, direct ventricular puncture under ultrasound and fluoroscopic guidance was performed. At end of case, protamine was given to reverse the heparin, and sheaths were pulled with purse-string suture closure of the skin entrance.
  
  
  RESULTS
  For right ventricular access, 8- to 9-F sheaths were placed from subxiphoid approach in 2 patients to allow conduit and pulmonary artery interventions. For left ventricular access in patients with mitral and aortic prostheses, 4- to 8-F sheaths were placed from apical approach to allow diagnostic evaluation in 1 and interventions in 5 to occlude perivalvular mitral leaks and postoperative ventricular septal defect. Complication in one consisted of intercostal vein injury resulting in hemothorax requiring chest tube drainage.
  
  
  CONCLUSIONS
  In this small cases series, direct ventricular puncture allowed the intervention to proceed with up to 9-F sheath size. Attention to puncture site relative to intercostal vascular anatomy is warranted.
authors.affiliation: Department of Pediatrics and Medicine, University of Virginia, Virginia, USA. SL9PC@virginia.edu
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.forename: John M
authors.initials: JM
authors.lastname: Dent
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles; D006493:Heparin / Q000627:therapeutic use; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011479:Protamines / Q000627:therapeutic use; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin