Radiofrequency-powered transseptal puncture during left atrial appendage closure caused an unrecognized, life-threatening descending aorta perforation in a 57-year-old woman.
Case Report (n=1)
Radiofrequency-powered systems for transseptal puncture can cause life-threatening descending aorta perforation, particularly in the presence of an interatrial septum aneurysm.
Background Aortic root injury during transseptal puncture (TSP) is a rare but well-recognized complication. However, injury to the descending aorta has not previously been described in this context.Case Summary A 57-year-old woman underwent left atrial appendage closure. During TSP using the VersaCross Connect radiofrequency-powered system and a 15-F steerable sheath, an unrecognized perforation of the descending aorta occurred. Despite repeated transthoracic echocardiograms showing no pericardial effusion and initial hemodynamic stability, she subsequently developed a mediastinal hematoma and bilateral pleural effusion. Management required an emergency percutaneous thoracic endovascular aortic repair, followed by surgical evacuation of the hematoma.Discussion Excessive tenting during radiofrequency-powered TSP, related to interatrial septum aneurysm, resulted in injury to the descending aorta with life-threatening consequences.Take-home Message Radiofrequency-powered systems for TSP have enhanced tissue penetration capability and should therefore be used with caution, particularly in the presence of an interatrial septum aneurysm and atypical echocardiographic windows.
Bini et al. (Sat,) conducted a case report in Left atrial appendage closure (n=1). Transseptal puncture using VersaCross Connect radiofrequency-powered system was evaluated on Descending aorta perforation. Radiofrequency-powered transseptal puncture during left atrial appendage closure caused an unrecognized, life-threatening descending aorta perforation in a 57-year-old woman.