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Delayed abrupt tamponade by isolated left atrial compression following coronary artery perforation during coronary
Gérald R Barbeau1, Mario Sénéchal, Pierre Voisine
1Department of Cardiology, Laval Hospital, Québec, Canada. gerald.barbeau@med.ulaval.ca
Insights
Delayed cardiac tamponade after coronary artery perforation during angioplasty is rare. This study presents two cases of abrupt, delayed tamponade caused by left atrial compression following contained coronary artery perforation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous coronary intervention (PCI) can lead to coronary artery perforation, a rare complication.
- Cardiac tamponade is a potentially life-threatening consequence of coronary artery perforation.
- Ellis classification system categorizes coronary perforations based on severity and management approach.
Observation:
- This report details two unique cases of delayed cardiac tamponade.
- The tamponade occurred abruptly, presenting as localized left atrial compression.
- The underlying cause was contained coronary artery perforation during angioplasty.
Findings:
- Unlike rapid tamponade seen with Ellis type III perforations, these cases involved delayed onset.
- Contained coronary artery perforations (Ellis type I and II) typically have conservative management.
- These cases highlight an extremely rare presentation of delayed tamponade after PCI.
Implications:
- Clinicians should consider delayed cardiac tamponade in patients with coronary artery perforation, even if initially contained.
- Prompt diagnosis and management are crucial for favorable outcomes.
- Further research into the mechanisms and risk factors for delayed tamponade is warranted.
Abstract:
Cardiac tamponade following coronary artery perforation during percutaneous coronary intervention is a rare but potentially life-threatening complication. When associated with Ellis type III coronary perforations, tamponade develops rapidly during the intervention. In contrast, Ellis type I and II coronary perforations, because of their contained nature, are usually managed conservatively and rarely result in tamponade. We report two unusual cases of delayed but abrupt tamponade caused by localized left atrial compression after contained coronary artery perforation following angioplasty. This complication is an extremely rare event. Etiology, diagnostic modalities, and management are discussed.
