[A rare case of coronary artery perforation by a PTCA guide wire complicating with postinfarction cardiac rupture after thrombolytic therapy]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Acute myocardial infarction necessitates timely intervention.
• Percutaneous transluminal coronary angioplasty (PTCA) is a common treatment for myocardial infarction.
• Thrombolytic therapy, like tissue plasminogen activator (t-PA), is used to restore blood flow.

Observation:

• A patient with extensive anterior wall acute myocardial infarction developed cardiac rupture and tamponade during emergency PTCA.
• The injury was caused by a guide wire used during PTCA, perforating the meandering left anterior descending artery (LAD).
• A small, oozing-type cardiac rupture was also noted near the apex.

Findings:

• Coronary artery perforation by a PTCA guide wire is a rare but serious complication.
• Meandering coronary arteries may increase the risk of guide wire perforation.
• Guide wire perforation can lead to significant hemorrhagic complications, including cardiac rupture and tamponade, particularly after thrombolytic therapy.

Implications:

• Urgent surgical repair of both the perforated coronary artery and the ruptured ventricle is crucial for patient survival.
• Awareness of this complication is important for interventional cardiologists, especially when treating patients with complex coronary anatomy or those who have received thrombolytic therapy.
• This case highlights the potential risks associated with PTCA in the context of thrombolysis and complex coronary anatomy.