Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment

Aris Karatasakis, Yasir N. Akhtar, Emmanouil S. Brilakis

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)412-417
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume17
Issue number6
DOIs
StatePublished - Sep 1 2016

Keywords

  • Complications
  • Outcomes
  • Percutaneous coronary intervention
  • Perforation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment'. Together they form a unique fingerprint.

Cite this