Liu Chao, Peng Rongbing, Zhao Xianxian, Guo Zhifu, Yu Manli
Department of Cardiology, Changhai Hospital, Shanghai 200433, China.
Eur Heart J Case Rep. 2025 Jan 16;9(1):ytaf014. doi: 10.1093/ehjcr/ytaf014. eCollection 2025 Jan.
Several studies have demonstrated a notable increase in the incidence of atrial arrhythmias among individuals with atrial septal defect (ASD) occluder. Although the sequential dilation technique has been proposed as the mainstream technique for transseptal puncture with ASD occluder, it is associated with substantial risks and technical difficulties.
We report a patient who underwent catheter ablation for atrial fibrillation and had a large ASD occluder. A balloon was dislodged into the patient's right superior pulmonary vein (RSPV) during a transseptal puncture and was successfully captured. The most notable feature of this case was the dislodgement of the dilation balloon, which has not been reported previously.
Repeated and gradual dilation of the pathway with a pressure balloon is unavoidable during the establishment of the left atrial channel. It is not recommended to choose a coronary balloon and Run-through guidewire. Since only the tip of the coronary balloon is connected to the guide wire, it cannot stably guide the balloon through the puncture hole. When using over-the-wire balloon or peripheral vascular balloon, the balloon can stably attach to the guide wire as a whole, which allows movement along the puncture hole. The puncture hole can be safely expanded using a peripheral vascular balloon combined with a loach guidewire in subsequent expansion. In addition, it is important to avoid violent manipulation. After confirming the dislodgement of the balloon, it is imperative to remove it. Relying solely on oral anticoagulation may not sufficiently decrease the risk of thrombosis.
多项研究表明，患有房间隔缺损（ASD）封堵器的个体中心房心律失常的发生率显著增加。尽管序贯扩张技术已被提议作为ASD封堵器经房间隔穿刺的主流技术，但它存在重大风险和技术困难。
我们报告了一名接受房颤导管消融且有大型ASD封堵器的患者。在经房间隔穿刺过程中，一个球囊移位至患者右上肺静脉（RSPV），并成功捕获。该病例最显著的特征是扩张球囊的移位，此前未见报道。
在建立左心房通道过程中，使用压力球囊对路径进行反复逐渐扩张是不可避免的。不建议选择冠状动脉球囊和贯穿导丝。由于冠状动脉球囊仅尖端与导丝相连，无法稳定引导球囊通过穿刺孔。使用钢丝外球囊或外周血管球囊时，球囊可整体稳定附着于导丝，从而能沿穿刺孔移动。在后续扩张中，可使用外周血管球囊结合泥鳅导丝安全地扩张穿刺孔。此外，避免暴力操作很重要。确认球囊移位后，必须将其取出。仅依靠口服抗凝可能不足以降低血栓形成风险。
