The IX t h Makassed Medical Congress - American University of Beirut

T h e I X t h M a k a s e d M e d i c a l C o n g r e s s
detect the presence and persistence of edge dissections, assess vascular responses such as
remodeling, study edge effects, compare overlapping with nonoverlapping segments, and look
for causes of restenosis and thrombosis.
In conclusion, IVUS provides unique insights during DES implantation, allows DES optimization
and should always be used during the management of DES failures: in-stent restenosis and DES
thrombosis.
MANAGEMENT OF HAEMOPERICARDIUM DURING PERCUTANEOUS MITRAL
COMMISSUROTOMY
Georges Ghanem MD, FESC, FACC
Background: Haemopericardium is a severe complication of percutaneous mitral commissurotomy
(PMC) due to transseptal catheterization. There are no particular recommendations in the literature
on the management of this complication during PMC. Our objective is to review and analyze the
cases of haemopericardium in a series of 245 patients, and provide certain recommendations for
its management during PMC.
Patients and Methods: Between January 1993 and December 2008, 60 males and 218 females
with severe mitral stenosis were enrolled. The mean age was 44 years old. 89% were class III NYHA.
The mean echo score was 8.5.
Results and Haemopericardium Management: The Inoue technique was used for all the
procedures. Overall, the procedure was performed successfully in 98%. Death occurred in 0, 4%,
severe mitral regurgitation occurred in 0, 8% and haemopericardium in 2, 1% (all female patients).
The management of haemopericardium in these patients was as follows: The 1st patient, a 45
year-old female, was sent immediately to surgery for open pericardiocentesis and mitral valve
replacement. The 2nd patient, a 28 year-old female, had a pericardiocentesis in the cath lab,
and then surgery was performed on an elective basis. The 3rd patient, a 50 year-old female, had a
pericardiocentesis in the cath lab, and then 24 hours later a PMC was done with successful results.
The 4th patient, a 35 year-old 7-months pregnant female, was managed as follows: Heparin was
immediately reversed with Protamin. Then, a pericardiocentesis was performed after 6F sheath
installation into the pericardium under echo-guidance.
We Reinjected the drained blood from the pericardium into systemic circulation via the femoral
vein.
Due to pregnancy, the patient was at high risk for surgery, therefore, the procedure was
continued with one balloon inflation immediately at the appropriate diameter corresponding to
the patient’s height (height/10 + 10) with successful result. The follow-up and the delivery were
totally normal.
The 5th and 6th patients, 53 and 64 year-old females, were managed exactly the same way
as the 4th patient with successful results. To note that the 5 th patient was operated for open
pericardiocentesis on the cath lab table for a large posterior right atrium tear, immediately after
a successful dilatation of the valve and balloon retrieval.
Conclusion: Although haemopericardium is a complication of PMC, our clinical experience demonstrates
that it could be successfully managed in the cath lab through continuing PMC after pericardiocentesis and
heparin reversing.
Such management regime could be particularly beneficial for patients at high risk for surgery (ex. pregnancy).
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