A case of ventricular septal rupture associated with major septal branch occlusion after percutaneous coronary
Toru Yoshizaki1, Marina Ishida1, Tamotsu Takagi1
1Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
Insights
Percutaneous coronary intervention (PCI) can rarely lead to septal branch occlusion, potentially causing ventricular septal rupture. This case highlights a rare complication of PCI, emphasizing the need for awareness during procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for stable angina.
- Septal branch occlusion during PCI is an infrequent complication.
- Ventricular septal rupture (VSR) is a severe complication typically associated with acute myocardial infarction.
Observation:
- A 67-year-old man developed dyspnea and signs of heart failure post-PCI.
- Imaging revealed lung congestion, pleural effusion, and basal VSR.
- Coronary angiography confirmed persistent occlusion of the septal branch, without in-stent restenosis.
Findings:
- The patient underwent successful surgical closure of the VSR.
- The septal branch occlusion, a rare complication of PCI, was implicated in the VSR development.
- This case underscores the potential for serious consequences from seemingly minor procedural events.
Implications:
- Clinicians should be aware of rare complications like VSR following PCI, even in stable angina patients.
- Persistent septal branch occlusion, though uncommon, can lead to significant morbidity.
- Vigilance and prompt management are crucial for patients presenting with delayed complications after PCI.
Abstract:
A 67-year-old man underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery. The major septal branch became occluded during coronary stenting. The patient developed dyspnea 19 days later. Chest radiography revealed lung congestion and a pleural effusion. Transthoracic echocardiography revealed a basal ventricular septal rupture. Emergency coronary angiography did not reveal any in-stent restenosis, and the major septal branch remained occluded. Therefore, the patient underwent closure of the ventricular septal rupture. The postoperative period was uneventful, and he was discharged 29 days after the operation. Septal branch occlusion due to coronary stenting occasionally occurs during routine PCI for which recanalization is sometimes not attempted. However, this case demonstrates that occluded septal branches, although rare, may cause serious complications. <Learning objective: Rupture of the ventricular septum, a complication of acute myocardial infarction, is usually observed in the setting of acute myocardial infarction associated with major coronary artery occlusion. However, ventricular septal rupture associated with side branch occlusion due to coronary stenting for stable angina pectoris is uncommon. Awareness of this rare complication is useful during routine percutaneous coronary intervention.>.
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