The hidden skills of the cryoballoon: occlusion of cardiac perforation in a patient with persistent left superior vena cava-a case report

Background Cardiac tamponade is one of the most serious complications when performing cardiac interventions. Although most of the patients can be treated effectively using pericardiocentesis, urgent surgery can be necessary in case of continuous bleeding and patients' haemodynamic impairment. Case summary With this unique clinical case report we describe an acute endovascular occlusion of a cardiac perforation utilizing the inflated 28 mm cryoballon at the transseptal puncture site close to the superior part of the coronary sinus ostium in a patient with persistent left superior vena cava (PLSVC) and severe post-procedural tamponade. Prior to this maneuver, 1200 mL of haemorrhagic effusion has been aspirated. Forty-five minutes after cryoballoon-guided occlusion we deflated the balloon and no additional blood could be aspirated over the following 20 minutes. Discussion Cryoballon-guided occlusion of the perforation site saved the patient from immediate cardiac surgery and resulted in stable haemodynamic conditions. This bailout approach was transferred from coronary interventions where occlusion of a perforated vessel using balloon devices is a common technique to achieve acute hemostasis.