title: Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment.
abstract: In patients with prior coronary artery bypass graft (CABG) surgery, distal coronary perforations are commonly considered to be at low risk for causing cardiac tamponade due to a potential protective role of pericardial adhesions, which obliterate the pericardial space. Loculated effusions can however form in such patients, compressing various cardiac structures and causing hemodynamic compromise. We present two cases of distal coronary perforation in prior CABG patients undergoing chronic total occlusion percutaneous coronary intervention. In the first case a distal coronary perforation was initially observed, resulting in a loculated pericardial effusion that caused ST-segment elevation and death, despite successful sealing of the perforation. In the second case a similar perforation was immediately sealed with a covered stent, followed by uneventful patient recovery. A literature review of coronary perforation leading to hemodynamic compromise in patients with prior CABG surgery revealed high mortality (22%), suggesting that prompt sealing of the perforation is critical in these patients.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: aris.karatasakis@gmail.com.
authors.forename: Aris
authors.initials: A
authors.lastname: Karatasakis
authors.affiliation: Tennova Healthcare, Knoxville, TN, USA. Electronic address: yasir.akhtar@ethc.com.
authors.forename: Yasir N
authors.initials: YN
authors.lastname: Akhtar
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation; D010490:Pericardial Effusion / Q000209:etiology; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Complications; Outcomes; Percutaneous coronary intervention; Perforation