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[Left ventricular rupture following the procedure of percutaneous transluminal coronary angioplasty: a case report]
Insights
Percutaneous transluminal coronary angioplasty (PTCA) failure in severe left anterior descending artery stenosis can lead to left ventricular rupture. Immediate surgical intervention is crucial for patient survival following such complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery stenosis.
- Severe stenosis, particularly in the left anterior descending artery, presents significant challenges during PTCA.
- Guide wire passage failure and contrast extravasation are recognized complications during complex PTCA.
Observation:
- A 50-year-old male patient with 90% proximal left anterior descending artery stenosis experienced PTCA failure due to guide wire non-passage.
- Contrast staining outside the coronary artery was observed during the procedure.
- Four hours post-procedure, the patient developed shock with electro-mechanical dissociation.
Findings:
- Emergent surgery revealed a left ventricular rupture.
- The rupture was surgically repaired, and a saphenous vein bypass to the left anterior descending artery was performed.
- The patient could not be weaned from cardiopulmonary bypass despite rapid surgical intervention.
Implications:
- This case highlights the critical risk of left ventricular rupture following failed PTCA in complex coronary lesions.
- Immediate surgical backup and close interdisciplinary communication between cardiologists and surgeons are vital for managing severe ischemic events after PTCA failure.
- Prompt recognition and management are essential for improving outcomes in patients experiencing catastrophic complications during interventional cardiology procedures.
Abstract:
A 50-year-old man with 90% concentric stenosis at the proximal portion of the left anterior descending artery was tried to be treated with percutaneous transluminal coronary angioplasty (PTCA). The guide wire did not pass through the stenotic portion, and the staining out of coronary artery was recognized. Four hours after the procedure, he fell to shock status with a sign of electro-mechanical dissociation. An emergent operation confirmed the left ventricular rupture. Repair of the tear and saphenous vein bypass to the left anterior descending artery were performed rapidly, however, he was not weaned from cardiopulmonary bypass. Close communication between cardiologist and surgeon, and immediate surgical back up are essential for saving these patients from severe ischemic events following PTCA failure.