Fiore A, Grandmougin D, Maureira J P, Elfarra M, Laurent N, Andronache M, Folliguet T, Villemot J P
Department of Cardiovascular Surgery and Heart Transplantations, ILCV Louis-Mathieu CHU Nancy, Vandoeuvre-lès-Nancy, France -
J Cardiovasc Surg (Torino). 2014 Apr;55(2):295-8.
Catheter ablation is a well-established therapeutic option for management of recurrent ventricular tachycardia in patients with ischemic/non-ischemic heart disease and procedural complications include a mortality rate of up to 3% and a risk of major complications up to 10%. Cardiac perforation following a catheter ablation is rare but serious complication and occurs in 1% of ventricular ablation procedures. The appropriate surgical repair may be challenging and need cardiopulmonary bypass support according to the location of the lesion and the hemodynamic status of the patient. We report the case of a free wall right ventricular perforation of the interventricular groove with cardiac tamponade following catheter ablation for recurrent ventricular tachycardia. Due to the proximity of the left anterior descending artery and the extreme fragility of tissues, the patient was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoSil®). This technique is a safe and effective surgical option to repair a ventricular perforation especially when the ventricular tissues are fragile. It is simple and enable to realize surgical repair also if the localization of tear is difficult to access and without the need for cardiopulmonary bypass support if hemodynamic conditions are stable.
导管消融是治疗缺血性/非缺血性心脏病患者复发性室性心动过速的一种成熟的治疗选择，手术并发症包括高达3%的死亡率和高达10%的主要并发症风险。导管消融后心脏穿孔是一种罕见但严重的并发症，发生在1%的室性消融手术中。根据病变位置和患者的血流动力学状态，进行适当的手术修复可能具有挑战性，并且需要体外循环支持。我们报告了一例在导管消融复发性室性心动过速后，室间沟右心室游离壁穿孔并伴有心脏压塞的病例。由于左前降支动脉位置接近且组织极度脆弱，该患者通过使用纤维蛋白组织粘合剂胶原绒（TachoSil®）的无缝合补片技术成功治疗。该技术是修复心室穿孔的一种安全有效的手术选择，特别是当心室组织脆弱时。它很简单，即使撕裂部位难以接近也能实现手术修复，并且如果血流动力学条件稳定，则无需体外循环支持。
