Accidental left ventricular perforation during coronary angiogram

Myocardial perforation (MP) is an uncommon entity which occurs most commonly in the setting of acute myocardial infarction. We report a case of accidental left ventricular perforation during a routine coronary angiogram. A 55-year-old male, known diabetic with moderate renal impairment, non-hypertensive, suffered an acute inferior wall myocardial infarction for which he was thrombolyzed with streptokinase. Coronary angiogram was done for postmyocardial infarction angina. Judkin right, 6F diagnostic catheter was used for left ventriculogram. After the ventriculogram the patient became hemodynamically unstable. A repeat left ventriculogram with a 6F pigtail catheter showed a perforation of the basal inferoposterior wall. Two pigtail catheters were inserted into the pericardial cavity to relieve the pericardial tamponade. Emergency surgical repair of a 1.5 cm rent in the inferior wall of the left ventricle was attempted. The friable and infarcted myocardium prevented a successful repair and the patient died after 24 hours.