{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T18:14:21Z","timestamp":1774289661670,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,10,28]],"date-time":"2014-10-28T00:00:00Z","timestamp":1414454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health","award":["Z01-HL006040-01, Z01-HL005062."],"award-info":[{"award-number":["Z01-HL006040-01, Z01-HL005062."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> We test the safety of transatrial pericardial access using small catheters, infusion of carbon dioxide (CO<jats:sub>2<\/jats:sub>) or iodinated contrast to facilitate sub\u2010xiphoid access, and catheter withdrawal under full anticoagulation. <jats:bold>Background:<\/jats:bold> Sub\u2010xiphoid pericardial access is required for electrophysiological and structural heart interventions. If present, an effusion protects the heart from needle injury by separating the myocardium from the pericardium. However, if the pericardium is \u2018dry' then there is a significant risk of right ventricle or coronary artery laceration caused by the heart beating against the needle tip. Intentional right atrial exit is an alternative pericardial access route, through which contrast media could be infused to separate pericardial layers. <jats:bold>Methods:<\/jats:bold> Transatrial pericardial access was obtained in a total of 30 Yorkshire swine using 4Fr or 2.8Fr catheters. In 16 animals, transatrial catheters were withdrawn under anticoagulation and MRI was performed to monitor for pericardial hemorrhage. In 14 animals, iodinated contrast or CO<jats:sub>2<\/jats:sub> was infused before sub\u2010xiphoid access was obtained. <jats:bold>Results:<\/jats:bold> Small effusions (mean 18.5 ml) were observed after 4Fr (1.3 mm outer\u2010diameter) but not after 2.8Fr (0.9 mm outer\u2010diameter) transatrial catheter withdrawal despite full anticoagulation (mean activated clotting time 383 sec), with no hemodynamic compromise. Pericardial CO<jats:sub>2<\/jats:sub> resorbed spontaneously within 15 min. <jats:bold>Conclusions:<\/jats:bold> Intentional transatrial exit into the pericardium using small catheters is safe and permits infusion of CO<jats:sub>2<\/jats:sub> or iodinated contrast to separate pericardial layers and facilitate sub\u2010xiphoid access. This reduces the risk of right ventricular or coronary artery laceration. 2.8Fr transatrial catheter withdrawal does not cause any pericardial hemorrhage, even under full anticoagulation. \u00a9 2014 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ccd.25698","type":"journal-article","created":{"date-parts":[[2014,10,15]],"date-time":"2014-10-15T03:13:36Z","timestamp":1413342816000},"source":"Crossref","is-referenced-by-count":11,"title":["Intentional right atrial exit for microcatheter infusion of pericardial carbon dioxide or iodinated contrast to facilitate sub\u2010xiphoid access"],"prefix":"10.1002","volume":"86","author":[{"given":"Toby","family":"Rogers","sequence":"first","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanishka","family":"Ratnayaka","sequence":"additional","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda Maryland"},{"name":"Department of Cardiology Children's National Medical Center  Washington DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William H.","family":"Schenke","sequence":"additional","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony Z.","family":"Faranesh","sequence":"additional","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Mazal","sequence":"additional","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William W.","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam B.","family":"Greenbaum","sequence":"additional","affiliation":[{"name":"Institute for Structural Heart Disease, Division of Cardiology, Henry Ford Health System Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Lederman","sequence":"additional","affiliation":[{"name":"Cardiovascular and Pulmonary Branch, Division of Intramural Research National Heart Lung and Blood Institute, National Institutes of Health Bethesda 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