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A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and

Melik Demir1, Murat Gök1, Muhammet Gürdoğan1

  • 1Department of Cardiology Trakya University Faculty of Medicine, Edirne - Turquia.

Arquivos Brasileiros De Cardiologia
|September 6, 2023
PubMed

Insights

A misimplanted coronary stent during percutaneous coronary intervention (PCI) caused a rare complication: interventricular septal hematoma, right ventricular fistula, and outflow tract obstruction. Management strategies for this challenging PCI complication were detailed.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary-cameral fistulas are typically congenital but can arise from trauma or percutaneous coronary interventions (PCIs).
  • Interventricular septal (IVS) hematomas are occasionally seen after chronic total occlusion (CTO) interventions and usually resolve without issue.

Observation:

  • This case presents a rare complication following PCI involving a misimplanted coronary stent in a septal perforating artery (SPA).
  • The complication manifested as an IVS hematoma, a right ventricular (RV) fistula, and significant right ventricular outflow tract (RVOT) obstruction.

Findings:

  • The misimplanted stent in the SPA was identified as the cause of the complex PCI complication.
  • The patient's condition involved a fistula between the coronary artery and the ventricle, alongside a hematoma within the septum.

Implications:

  • This case highlights the potential for serious complications from PCI, even with CTO interventions.
  • Effective management strategies are crucial for addressing rare but severe outcomes like RVOT obstruction secondary to coronary fistulas and hematomas.
  • Understanding these rare complications is vital for interventional cardiologists to improve patient safety and procedural outcomes.

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