Right ventricular perforation due to femoral venous cannulation during endoscopic mitral valve replacement: A rare case report

Abstract

Background:
Complications related to femoral venous cannulation are relatively rare, typically limited to local issues such as subcutaneous fluid collection or surgical site infection. Case reports in the literature indicate that right ventricular perforation is an extremely rare complication, with no sufficiently large statistical data to estimate its incidence.

Case Presentation:
We report a case of a 70-year-old female patient diagnosed with severe rheumatic mitral stenosis who underwent totally endoscopic mitral valve replacement using a bioprosthetic valve. Cardiopulmonary bypass was established via the right femoral artery, right femoral vein, and left superior vena cava using the Seldinger technique. During surgery, the patient developed a right ventricular perforation caused by the femoral venous cannula. The injury was successfully repaired through an endoscopic approach. At 6 months postoperatively, the patient demonstrated stable clinical status and normal transthoracic echocardiography findings.

Discussion:
Complications associated with femoral venous cannulation are uncommon, particularly right ventricular perforation. Several authors have recommended the use of transesophageal echocardiography (TEE) to reduce serious complications such as cardiac injury. However, adverse events may still occur even with TEE guidance. Attention to specific technical details can help reduce the risk of this complication. Surgical repair of such injuries can be performed via a minimally invasive or open approach, depending on the extent of injury, intraoperative conditions, and the surgeon’s experience.

Conclusion:
Femoral venous cannulation for establishing cardiopulmonary bypass is a relatively safe technique, but potential complications remain. Identification of technical pitfalls and application of appropriate preventive strategies are essential to minimize risk. In cases of right ventricular perforation, the lesion can be effectively managed via a minimally invasive surgical approach.