{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:19:24Z","timestamp":1770506364187,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2008,12,16]],"date-time":"2008-12-16T00:00:00Z","timestamp":1229385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2009,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:styled-content>Objective<\/jats:styled-content>: Interventional targets may be virtually \u201cexcluded\u201d due to vascular access problems or complex previous surgical procedures. This study reviews our experience using transapical ventricular puncture to gain direct access to the systemic ventricle. <jats:styled-content>Patients<\/jats:styled-content>: Patient 1 (74 years, 2 previous sternotomies), patient 2 (66 years, 5 previous sternotomies), and patient 5 (69 years, 3 previous sternotomies) with prosthetic valves had paravalvular mitral valve leaks. Patient 3 (6.3 years, 2 previous sternotomies) with an extracardiac Fontan conduit, had a significant residual leak after two previous surgical attempts of patch closure of a severely regurgitant right atrioventricular valve. Patient 4 (10 months) had failure of standard ablation of the posteroseptal region of the mitral valve with persistent life\u2010threatening episodes of ventricular tachycardia. <jats:styled-content>Methods<\/jats:styled-content>: Procedures were performed under general anesthesia. Entry site was percutaneous in three patients and in two (and one conversion) a mini\u2010thoracotomy was used. Sheaths were placed (6 F) using standard Seldinger technique, followed by the procedure as required. Direct surgical closure of the puncture site was done in 4 patients and in patient 3, a percutaneous vascular occlusion device was used. <jats:styled-content>Results<\/jats:styled-content>: Easy and immediate access was obtained in all patients. The paravalvular leaks were crossed within seconds and completely closed with Amplatzer occluders. In patient 3 the valve was crossed using a Brokenbrough needle and a 12\u2010mm Amplatzer device was placed in the patch leak. Patient 4 was successfully ablated using a 7\u2010F irrigated catheter endo\u2010 and epicardially. Complications were in the percutaneous puncture group: in one patient a coronary artery was punctured and in one a hemothorax developed. <jats:styled-content>Conclusion<\/jats:styled-content>: Direct left ventricular puncture offers a very useful alternative access site in selected patients to reach \u201cinaccessible\u201d targets for certain percutaneous interventions in patients where standard approaches may be impossible or difficult. \u00a9 2009 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ccd.21939","type":"journal-article","created":{"date-parts":[[2008,12,19]],"date-time":"2008-12-19T00:13:01Z","timestamp":1229645581000},"page":"137-142","source":"Crossref","is-referenced-by-count":37,"title":["Transapical left ventricular access for difficult to reach interventional targets in the left heart"],"prefix":"10.1002","volume":"74","author":[{"given":"S.C.","family":"Brown","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.E.","family":"Boshoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Rega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Eyskens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Budts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Heidb\u00fcchel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Meyns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Gewillig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,6,15]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196408062710601"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.69.6.551"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.632927"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.65.5.256"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810350418"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1522-726X(200001)49:1<68::AID-CCD15>3.0.CO;2-5"},{"key":"e_1_2_7_8_2","first-page":"251","article-title":"Technique of apical left ventricular puncture revisited: A case report of double\u2010valve prosthesis evaluation","volume":"6","author":"Cata CF","year":"1994","journal-title":"J Invasive Cardiol"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810060312"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0304(199604)37:4<367::AID-CCD5>3.0.CO;2-9"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810090415"},{"key":"e_1_2_7_12_2","first-page":"1","article-title":"Surgical application of anterior percutaneous left heart puncture","volume":"43","author":"Greene DG","year":"1958","journal-title":"Surgery"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.12.1.37"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10073"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(97)00050-7"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21542"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.01.046"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2006.10.034"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21545"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21621"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.06.028"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fccd.21939","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.21939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T23:56:41Z","timestamp":1696723001000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.21939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,6,15]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2009,7]]}},"alternative-id":["10.1002\/ccd.21939"],"URL":"https:\/\/doi.org\/10.1002\/ccd.21939","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,6,15]]}}}