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Chapter-30 Complications of Transseptal Puncture and Management

BOOK TITLE: Percutaneous Mitral Valvotomy

Author
1. S Harikrishnan
2. R Meera
ISBN
9789352701926
DOI
10.5005/jp/books/14152_31
Edition
2/e
Publishing Year
2018
Pages
7
Author Affiliations
1. Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India, Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram, Kerala, India, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India, Sree Chitra Tirunal Institute for Medical, Sciences and Technology, Trivandrum, Kerala, India, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
2. Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India, Kerala Institute of Medical Sciences, Thiruvananthapuram, India, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
Chapter keywords
Transseptal puncture, cardiopulmonary resuscitation, CPR, hemopericardium, cardiac tamponade, percutaneous mitral valvotomy, PMV, autotransfusion

Abstract

The aim of this chapter is to focus on the complications and management of transseptal puncture. One of the important steps in percutaneous mitral valvotomy (PMV) is the transseptal puncture. The main complications of transseptal puncture are hemopericardium and cardiac tamponade. This chapter covers the suspected pericardial tamponade, reversal of heparin—protamine, autotransfusion, and thrombus formation in the septal puncture site. Hemopericardium and cardiac tamponade are usually recognized during, or immediately after a catheter-based procedure. In a large series of emergency pericardiocentesis following invasive and interventional procedures from Mayo clinic, 57% of patients had significant hemodynamic collapse and 17% needed cardiopulmonary resuscitation (CPR). Acute cardiac tamponade requires immediate paracentesis pericardii and drainage. Direct retransfusion of the pericardial blood via the femoral venous sheath helps maintain blood pressure.

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