Intractable Pulmonary Edema After PCI: An Extremely Rare Iatrogenic Mechanical Cause

Permanent aortic valve injury following percutaneous coronary intervention (PCI) is a rare but catastrophic complication that can cause acute severe aortic regurgitation (AR) and heart failure.

A 49-year-old man developed recurrent acute pulmonary edema after a failed staged PCI for chronic total occlusion of the left anterior descending artery. Transthoracic echocardiography revealed severe eccentric AR caused by a 7-mm injury to the noncoronary cusp and left cusp confirming iatrogenic cusp laceration. He underwent successful surgical repair with pericardial patch reconstruction and coronary artery bypass grafting, with excellent recovery.

Literature on catheter-induced aortic valve injury is sparse. This case highlights a rare cause of post-PCI shock where prompt echocardiography guided lifesaving surgical intervention.

Not all post-PCI cardiac decompensation is ischemic. Severe AR from iatrogenic aortic cusp injury, though rare, should be promptly excluded.