Cardiac tamponade arising from a venous source following anterograde dissection re-entry coronary angioplasty to a chronic total occlusion.
Cardiac tamponade is a rare complication of coronary intervention to chronic total occlusions (CTO PCI). We report a case of persistent bleeding from a venous source following successful anterograde dissection-reentry (ADR) CTO PCI. Pericardiocentesis was performed 1 h post-procedure for tamponade. Persistent bleeding was investigated with contrast transesophageal echocardiography, pericardial manometry and blood analysis. Coronary venography revealed subtle extravasation from a cardiac vein adjacent to the site of luminal re-entry. Coronary venous perforation using ADR CTO PCI has not previously been described; however, the volume of blood loss may be significant and surgical exploration may be appropriate.
Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonard's, NSW, 2065, Australia. eddanson@gmail.com.
E
E
Danson
Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonard's, NSW, 2065, Australia.
F
F
Arena
Monash Medical Centre, Melbourne, VIC, Australia.
J
J
Sapontis
Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonard's, NSW, 2065, Australia.
M
M
Ward
Cardiology Department, Royal North Shore Hospital, Reserve Road, St. Leonard's, NSW, 2065, Australia.
R
R
Bhindi
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology*; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D057772:Vascular System Injuries / Q000150:complications* / Q000175:diagnosis
Bleeding; Chronic total occlusions; Complications