ABSTRACT
Percutaneous transvenous mitral commissurotomy was performed successfully via the transjugular approach in a patient with severe rheumatic mitral stenosis and obstruction of the inferior vena cava due to prior liver transplantation. This case demonstrates the advantage of the jugular approach in patients with difficult anatomy.
Subject(s)
Catheterization , Jugular Veins/surgery , Liver Transplantation/adverse effects , Mitral Valve/surgery , Vena Cava, Inferior/pathology , Vena Cava, Inferior/surgery , Venous Thrombosis/etiology , Venous Thrombosis/therapy , Adult , Female , Humans , Jugular Veins/pathology , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/therapy , Postoperative Complications/etiology , Postoperative Complications/therapy , Reoperation , Rheumatic Heart Disease/etiology , Rheumatic Heart Disease/therapyABSTRACT
The use of anchor-based, collagen-derived vascular sealing devices in femoral vein punctures during right and left heart catheterizations or coronary interventions necessitating venous access for temporary pacemaker or hemodynamic monitoring has not been studied. We hypothesized that using these devices in the femoral vein would be practical and reliable. One hundred and ten consecutive patients undergoing right and left heart catheterization (56 patients, 51%) or coronary intervention (54 patients, 49%) were included in this study. Forty-five of the interventions received IIb/IIIa inhibitors in combination with heparin, enoxaparin, aspirin, and clopidogrel. The Angio-Seal device was successfully deployed in the femoral vein in all patients, whereas 93 (85%) received arterial Angio-Seal, 8 received Perclose, and 9 (8%) had manual pressure or a Fem-Stop applied to control arterial bleeding after deployment. We conclude that in patients undergoing transcatheter procedures requiring venous access, the use of an 8 Fr Angio-Seal to seal the femoral vein is safe and feasible.
