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Coronary Artery Perforation, Subepicardial Hematoma, and Cardiac Tamponade After Complex Percutaneous Coronary

Silvia Corona1,2, Vasile Sirbu3

  • 1Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy.

JACC. Case Reports
|November 3, 2021
PubMed

Insights

A fissured subepicardial hematoma and cardiac tamponade occurred after coronary artery perforation during percutaneous intervention. Surgical therapy was necessary for hemostasis when percutaneous sealing failed, highlighting the need for prompt recognition and cardiac surgery availability.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Complex percutaneous coronary interventions carry risks, including coronary artery perforation.
  • Coronary artery perforation can lead to serious complications such as cardiac tamponade.

Observation:

  • A case of fissured subepicardial hematoma and subsequent cardiac tamponade following coronary artery perforation during a complex percutaneous intervention is presented.
  • Initial attempts at percutaneous sealing of the perforation were insufficient to achieve hemostasis.

Findings:

  • Surgical therapy was ultimately required to successfully manage the bleeding and achieve hemostasis.
  • The patient's survival was contingent upon the prompt recognition of the complication and the availability of emergent cardiac surgical services.

Implications:

  • This case underscores the critical importance of preparedness for managing rare but life-threatening complications during interventional cardiology procedures.
  • Enhanced vigilance and rapid access to surgical intervention are paramount for improving patient outcomes in cases of coronary artery perforation with hemodynamic compromise.

Keywords:
CTO, chronic total occlusionEF, ejection fractionLAD, left anterior descendingLV, left ventriclePCI, percutaneous coronary interventionRCA, right coronary arterySEH, sub epicardial hematomaSTEMI, ST-segment elevation myocardial infarctionTEE, transesophageal echocardiographyTTE, transthoracic echocardiographycardiac surgerycardiac tamponadecoronary artery perforationpercutaneous coronary interventionpericardiocentesissubepicardial hematoma

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