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(Circulation. 2006;114:e549-e550.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Percutaneous Intervention to a Right Coronary Artery Vein Graft Complicated by Perforation Into the Right Heart

Zoë Astroulakis, MBBS, MRCP; Anthony Mathur, MB, BChir, MRCP, PhD

From the Cardiovascular Division, King’s College London (Z.A.), and the Department of Cardiology, The London Chest Hospital, (A.M.), London, United Kingdom.

Correspondence to Dr A. Mathur, Department of Cardiology, The London Chest Hospital, Bonner Rd, London E2 9JX, United Kingdom. E-mail a.mathur@qmul.ac.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 79-year-old woman was admitted to our center with troponin-positive acute coronary syndrome. The ECG on admission showed inferior ST changes. She had undergone coronary artery bypass graft surgery 12 years previously. Diagnostic coronary angiography was performed and revealed a tight lesion in the distal right coronary artery vein graft, which was directly stented. The first image taken after deployment revealed Thrombosis In Myocardial Infarction (TIMI) grade 0 flow. Subsequent views showed graft perforation with free extravasation of contrast into the right atrium and into the right ventricle (Figure). The patient remained cardiovascularly stable. The area of perforation was sealed with the use of 2 covered stents, with rapid cessation of contrast extravasation and restoration of TIMI grade 3 flow. Transthoracic echocardiography excluded a pericardial collection. She remained well and was discharged 3 days later after serial echocardiography continued to exclude a pericardial effusion. Coronary perforation complicating percutaneous intervention is rare, with an estimated incidence of 0.2% to 0.6%.¹ It tends to occur in the elderly and women and in association with atheroablative procedures.² It is believed that patients having undergone coronary artery bypass grafting are protected from the development of cardiac tamponade because surgery generally involves a pericardiotomy. However, a case of tamponade complicating percutaneous intervention on a proximal right vein graft lesion has recently been reported.³ An explanation for the perforation occurring directly into the right heart is that the right coronary artery graft overlies the right atrium, where, after 12 years, it was adherent. The . . . [Full Text of this Article]

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Circulation 2006 114: 1793. [Extract] [Full Text]