Related Experiment Video
Updated: May 22, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Successful surgical management of coronary perforation requiring pulmonary artery separation
Noriyuki Takashima1, Tomoaki Suzuki, Soh Hosoba
1Division of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan. ntaka@belle.shiga-med.ac.jp
Insights
A complex coronary artery perforation was successfully treated with emergency surgery involving cardiopulmonary bypass and coronary artery bypass grafting. This case highlights adaptable surgical strategies for managing rare coronary artery perforation complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Surgical Anatomy
Background:
- Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions.
- Type III coronary perforation, involving perforation near major adjacent structures, presents unique surgical challenges.
- Standardized surgical strategies for complex coronary perforations are lacking, necessitating individualized approaches.
Observation:
- A 73-year-old woman experienced a type III coronary perforation of the proximal circumflex artery during a failed angioplasty.
- Bleeding from the perforation site was difficult to control on a beating heart due to its location behind the main pulmonary artery.
- Emergency surgery was required to manage the life-threatening hemorrhage.
Findings:
- Cardiopulmonary bypass was established to facilitate surgical access and control.
- The main pulmonary artery was carefully separated to achieve hemostasis at the perforation site.
- Coronary artery bypass grafting was successfully performed to the distal circumflex artery, restoring blood flow.
- The patient experienced an uneventful postoperative recovery and was discharged on the tenth day.
Implications:
- This case demonstrates a novel surgical approach for managing a previously undescribed scenario of coronary artery perforation.
- Adaptability in surgical strategy based on specific patient anatomy is crucial for successful outcomes in complex coronary perforations.
- Effective management of coronary artery perforation requires a multidisciplinary approach and tailored surgical solutions.
Abstract:
A 73-year-old woman with type III coronary perforation caused by failed angioplasty underwent emergency operation. It was impossible to stop the bleeding from the beating heart because the proximal Cx, which was the perforation site, was behind the main pulmonary artery. After establishing cardiopulmonary bypass, we separated the main pulmonary artery to secure hemostasis and performed coronary artery bypass grafting to the distal Cx. The postoperative course was uneventful therefore the patient was discharged on the tenth postoperative day. Surgical strategies are not standardized for coronary perforation and depend mainly on the surgical anatomy. In a situation like the present, which appears not to have been described previously, it is important to save the life of the patient by whatever means.
