Aortic root perforation during left-sided accessory pathway ablation managed percutaneously with an multifunctional occluder device

Figures

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  Figure 1. Baseline electrocardiogram showing negative delta in V1 and positive delta in I/aVL, indicating a right free wall pathway

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  Figure 2. (a) Fluoroscopic contrast injection through the sheath following transseptal puncture reveals inadvertent entry into the aortic root, (b) Emergency pericardiocentesis performed following cardiac arrest due to cardiac tamponade. (c) Aortic root angiogram immediately after KONAR-multifunctional occluder device deployment shows pericardial contrast staining with ongoing leak, (d) Repeat angiogram after 10 min demonstrates resolution of extravasation and effective sealing of the perforation. MFO: Multifunctional occluder

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  Figure 3. Postprocedure transthoracic echocardiogram demonstrates the KONAR-multifunctional occluder device well-seated across the defect in the noncoronary cusp, with no evidence of residual pericardial effusion

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  Figure 4. (a) Ventricular pacing demonstrates a manifest accessory pathway with eccentric retrograde atrial activation. The earliest atrial signal is recorded in the distal coronary sinus (CS 1–2), (b) Electrogram recordings at the distal ablation catheter reveal signals occurring 25 msonds before the atrial signals in CS 1–2, (c) Radiofrequency ablation at this site results in termination of accessory pathway conduction within 3.2 s, with a shift in atrial activation from eccentric to concentric, (d) During continued ventricular pacing, ventriculoatrial dissociation is demonstrated at a cycle length of 350 msonds, confirming successful accessory pathway ablation