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Delayed ventricular septal perforation caused by minimal branches occlusion during coronary artery stenting

Noriyuki Fujii1, Kazufumi Tsuchihashi, Junichi Nishida

  • 1Department of Cardiology, Sapporo Social Insurance General Hospital, Atsubetsu-chuo 2-6, Atsubetsu-ku, Sapporo, 004-8618, Hokkaido, Japan, norifuji2002@yahoo.co.jp.

Cardiovascular Intervention and Therapeutics
|April 3, 2013
PubMed

Insights

A rare complication following coronary stenting, ventricular septal perforation, occurred in a 75-year-old woman. This event was linked to the occlusion of small septal branches during the procedure.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Stable effort angina pectoris is a common presentation of coronary artery disease.
  • Percutaneous coronary intervention (PCI) with stenting is a standard treatment for significant coronary stenosis.
  • Complications, though rare, can occur following PCI.

Observation:

  • A 75-year-old woman underwent successful stenting for 90% stenosis of the left anterior descending artery.
  • Three months post-procedure, a new systolic heart murmur was detected, indicating a potential cardiac issue.
  • Computed tomography confirmed ventricular septal perforation (VSP).

Findings:

  • Coronary angiography revealed occlusion of two small septal branches immediately after stenting, while the major septal branch remained patent.
  • These small septal branches remained occluded at the time of VSP diagnosis.
  • No stent restenosis was observed, suggesting the VSP was not directly caused by stent failure.

Implications:

  • Occlusion of small septal branches during PCI may be a potential cause of iatrogenic ventricular septal perforation.
  • Careful assessment of septal perforator anatomy and potential risks is crucial during complex PCI procedures.
  • This case highlights a rare but serious complication that warrants further investigation and potential preventative strategies.

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