It was reported that a pericardial effusion, tamponade, perforation has occurred.During a watchman procedure, a versacross connect kit was selected for use.The versacross radio frequency wire was being advanced into the superior vena cava (svc) however there was a difficulty noted to follow up to the svc.Some manipulations with versacross and watchman sheath was performed for about a minute or two to track wire to the svc and eventually found its path to the correct location.Transseptal was achieved without any issues and the watchman device was implanted.A small effusion was noted during our post procedural check.Effusion was observed for about fifteen minutes and was compared with pre-check transesophageal echocardiogram (tee) imaging of the effusion.It was difficult to determine if the effusion was present at baseline because of the grainy-ness of our pre-imaging.After waiting fifteen minutes, the effusion was unchanged and vital signs were stable.Patient was sent to recovery and upon waking began to complain of chest pains and pressures were noted to be slightly hypotensive.A transthoracic echocardiogram (tte) was ordered and effusion was notably larger than in the cath lab.A pericardiocentesis was performed and compression were given multiple times while pulling fluid off the pericardial space.The effusion was resolving upon draw back, but would continue to appear after a few moments.The patient would regain a pulse on and off during this time and cardiopulmonary resuscitation (cpr) was administered appropriately.Computed tomography (ct) surgery was requested and determined an open heart was necessary to stop the effusion.Upon further inspection during open heart the surgeon noted that a small perforation was found in the anterior aspect of the right atrium, approximately a 'wire sized' hole.The patient was sent to intensive care unit intubated and stable.The device is not expected to be returned for analysis.
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