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Compression of right ventricular out-flow due to localized hematoma after coronary perforation during PCI
Yoshiaki Kawase1, Motoya Hayase, Shigenori Ito
1Division of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan. kawase@heart-center.or.jp
Insights
Coronary perforation during percutaneous coronary intervention (PCI) rarely causes tamponade in patients with prior coronary artery bypass graft (CABG) surgery. This case highlights right ventricular outflow obstruction as a rare complication in such patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Coronary artery bypass graft (CABG) surgery can lead to pericardial adhesions, altering cardiac anatomy and potentially complicating subsequent interventions.
- Coronary perforation is a known, albeit uncommon, complication of PCI, typically managed with various closure techniques.
Observation:
- A rare case of right ventricular outflow obstruction occurred during PCI.
- The patient had a history of previous coronary artery bypass graft (CABG) surgery.
- Pericardial adhesions from prior CABG surgery were present.
Findings:
- The coronary perforation during PCI did not lead to the expected cardiac tamponade.
- Instead, the perforation complicated by the patient's specific anatomy resulted in right ventricular outflow obstruction.
- This suggests that pericardial adhesions can significantly alter the hemodynamic consequences of coronary perforation.
Implications:
- This case underscores the importance of considering unique anatomical factors in patients with prior CABG undergoing PCI.
- It highlights that right ventricular outflow obstruction can be a rare but serious complication of PCI in this specific patient population.
- Further investigation into the management and prevention of such complications in patients with prior CABG is warranted.
Abstract:
Although coronary perforation can cause tamponade during percutaneous coronary intervention (PCI), this is unusual for patients previously undergoing coronary artery bypass graft surgery (CABG) due to pericardial adhesions. We report here on a rare case of right ventricular out-flow obstruction complicating PCI in a patient with a previous CABG.