Right ventricular infarction following percutaneous coronary rotational atherectomy

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous coronary rotational atherectomy is a minimally invasive procedure used to treat complex coronary artery disease, particularly calcified lesions.
• Right ventricular infarction (RVI) is a serious complication that can occur following cardiac procedures, often associated with ischemia of the right ventricle.

Observation:

• This case report details a patient who developed RVI subsequent to undergoing rotational atherectomy for sequential calcified right coronary artery (RCA) lesions.
• The RVI was attributed to the inadvertent occlusion of two right ventricular marginal branches during the atherectomy procedure.

Findings:

• Successful rotational atherectomy of the RCA was achieved, despite the complication of RVI.
• The occlusion of the right ventricular marginal branches directly led to the observed right ventricular infarction.

Implications:

• This case highlights a potential, albeit rare, complication of rotational atherectomy in the RCA, emphasizing the need for careful technique and monitoring.
• Awareness of this complication is crucial for interventional cardiologists to optimize patient selection, procedural planning, and post-procedural management in similar cases.
• Further research may be warranted to elucidate the precise mechanisms and develop preventative strategies for RVI during RCA interventions.