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Fatal coronary artery spasm triggered before transseptal puncture for mitral transcatheter edge-to-edge-repair: a
Yujing Mo1, Jie Li1, Jianfang Luo1
1Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106, Zhongshaner Rd, Yuexiu Disctict, Guangzhou, Guangdong 510080, China.
Insights
Severe coronary artery spasms and dangerous heart rhythms occurred during a transseptal catheterization procedure. This highlights potential risks associated with transseptal puncture, even before the main intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Transseptal catheterization is a common procedure.
- Transient coronary artery spasm during this procedure is known but usually mild.
Observation:
- A case of severe multiple coronary artery spasms was observed.
- This occurred alongside advanced atrioventricular block and ventricular fibrillation.
- The event happened during sheath catheter compression of the fossa ovalis, prior to mitral transcatheter edge-to-edge repair.
Findings:
- Severe coronary artery spasms can be triggered by transseptal catheterization.
- These spasms can lead to life-threatening arrhythmias like ventricular fibrillation.
- Mechanical tension on the interatrial vagal network is a potential cause.
Implications:
- This case underscores the importance of recognizing and managing potential cardiac complications during transseptal procedures.
- Further investigation into the mechanism of vagal nerve stimulation is warranted.
- This may inform procedural modifications to mitigate risks.
Background:
Transient ST-segment elevation or coronary artery spasm during transseptal catheterization has been previously described. Most cases were either reversible or asymptomatic.
Case Summary:
We present a case of severe multiple coronary artery spasms with advanced atrioventricular block and ventricular fibrillation during compression of the fossa ovalis by a sheath catheter, before the performance of the transseptal puncture procedure for mitral transcatheter edge-to-edge-repair.
Discussion:
The mechanical effects of forward tension from transseptal puncture on the interatrial vagal network could be the most possible explanation for the occurrence of this phenomenon.
