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Managing low profile - left main transmural laceration
Rutger L Anthonio1, Gillian A J Jessurun, Michiel E Erasmus
1Department of Cardiology, University Medical Centre Groningen Thorax Centre, The Netherlands. r.l.anthonio@thorax.azg.nl
Insights
A rare complication of aortic valve replacement surgery, chronic left main stem perforation, was successfully treated with a percutaneous approach. This minimally invasive technique sealed the perforation and resolved the associated hematoma.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Combined aortic valve replacement and bypass surgery can lead to rare complications.
- Perforation of the left main coronary artery is a serious, though infrequent, complication.
- Chronic, low-profile perforations pose unique diagnostic and therapeutic challenges.
Observation:
- A 70-year-old male developed chest pain one year after aortic valve replacement.
- Imaging revealed a slowly expanding hematoma secondary to a chronic left main coronary artery perforation.
- The patient presented with symptoms attributable to the expanding hematoma.
Findings:
- A tailored percutaneous intervention was performed to address the left main stem perforation.
- The procedure successfully sealed the chronic perforation.
- Coronary angiography at three months confirmed the successful sealing and hematoma regression.
Implications:
- Percutaneous coronary intervention offers a viable treatment option for chronic left main stem perforations.
- Minimally invasive techniques can effectively manage rare surgical complications.
- Successful management leads to symptom resolution and improved patient outcomes.
Abstract:
Perforation of the left main stem is a rare complication associated with combined aortic valve replacement and by-pass surgery. One-year following aortic valve replacement a 70-year-old male presented with chest pain. This was related to a slowly expanding haematoma caused by a low profile chronic perforation of the left main. Subsequently, a tailored percutaneous modification of the main stem was performed. At three months follow-up, he had no complaints and selective coronary angiography confirmed the successful sealing of the perforation with a concomitant regression of the prior haematoma.
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