title: Incidence and management of inadvertent puncture and sheath placement in the aorta during attempted transseptal puncture.
abstract: OBJECTIVE
  Transseptal punctures (TSP) are routinely performed in cardiac interventions requiring access to the left heart. While pericardial effusion/tamponade are well-recognized complications, few data exist on accidental puncture of the aorta and its management and outcome. We therefore analysed our single centre database for this complication.
  
  
  RESULTS
  We assessed frequency and outcome of inadvertent aortic puncture during TSP in consecutive patients undergoing ablation procedures between January 2005 and December 2014. During the 10-year period, two inadvertent aortic punctures occurred among 2936 consecutive patients undergoing 4305 TSP (0.07% of patients, 0.05% of TSP) and in one Mustard patient during attempted baffle puncture. The first two patients required left ventricular access for catheter ablation of ventricular tachycardia. In both cases, an 11.5F steerable sheath (inner diameter 8.5F) was accidentally placed in the ascending aorta just above the aortic valve. In the presence of surgical standby, the sheaths were pulled back with a wire left in the aorta. Under careful haemodynamic and echocardiographic observation, this wire was also pulled back 30 min later. None of the patients required a closing device or open heart surgery. None of the patients suffered complications from the accidental aortic puncture and sheath placement.
  
  
  CONCLUSIONS
  Inadvertent aortic puncture and sheath placement are rare complications in patients undergoing TSP for interventional procedures. Leaving a guidewire in place during the observation period may allow introduction of sheaths or other tools in order to control haemodynamic deterioration.
authors.forename: Kristina
authors.initials: K
authors.lastname: Wasmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Zellerhoff
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.forename: Gerold
authors.initials: G
authors.lastname: Mönnig
authors.forename: Christian
authors.initials: C
authors.lastname: Pott
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Dechering
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Lange
authors.forename: Gerrit
authors.initials: G
authors.lastname: Frommeyer
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D016208:Databases, Factual; D004867:Equipment Design; D005260:Female; D005858:Germany; D006346:Heart Septum / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Aortic puncture; Complication; Transseptal puncture