title: Surgical treatment for Ellis type 3 coronary perforation during percutaneous catheter intervention.
abstract: BACKGROUND
  Coronary perforation (CP) is a rare, but sometimes lethal, complication of percutaneous catheter intervention (PCI). We reviewed surgically-treated cases of type 3 CP during PCI.
  
  
  RESULTS
  From 2007 to 2010, 5 patients underwent surgical repair for type 3 CP (3 men, 2 women; mean age, 74 years). The mean number of diseased coronary branches was 2.6 and the mean SYNTAX score was 45. The target lesions were the left anterior descending artery in 4 cases and the right coronary artery in 1 case. Types of American Heart Association/American College of Cardiology classification were type B2 in only one case and type C in 4 cases. The causes of perforation were balloon inflation in 4 patients and rotational atherectomy in 1 patient. The in-hospital mortality rate was 20%. In the cases of CP associated with balloon inflation, coronary lacerations were so severe that re-bleeding occurred even if the covered stent could temporarily achieve hemostasis, and percutaneous cardiopulmonary support and emergency surgery were required.
  
  
  CONCLUSIONS
  CP induced by balloon inflation tends to result in a serious condition compared with rotablator-induced CP. Surgery should be immediately performed even after covered stent implantation if there is any possibility of re-bleeding in the case of balloon-induced type 3 CP.
authors: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Japan. toshinoritotsugawa@gmail.com
authors: Toshinori
authors: T
authors: Totsugawa
authors: Masahiko
authors: M
authors: Kuinose
authors: Hidenori
authors: H
authors: Yoshitaka
authors: Keijiro
authors: K
authors: Katayama
authors: Yoshimasa
authors: Y
authors: Tsushima
authors: Atsuhisa
authors: A
authors: Ishida
authors: Genta
authors: G
authors: Chikazawa
authors: Arudo
authors: A
authors: Hiraoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000706:statistics & numerical data; D017225:Atherectomy, Coronary / Q000009:adverse effects* / Q000706:statistics & numerical data; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000293:injuries; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome