Canadian Journal of Cardiology

Volume 27, Issue 3, May–June 2011, Pages 389.e25-389.e28
Canadian Journal of Cardiology

Case report
Localized Pulmonary Artery Compression Due to Saphenous Vein Graft Perforation During Percutaneous Coronary Intervention

https://doi.org/10.1016/j.cjca.2010.12.031Get rights and content

Abstract

Saphenous vein graft interventions are recognised as high risk procedures for adverse outcomes. We present a case of a ruptured vein graft causing a focal hematoma that led to pulmonary artery compression and cardiogenic shock without the classical signs of tamponade. Multi-modality imaging revealed the aetiology and the hematoma resolved after the patient received cardio-pulmonary resuscitation during attempted percutaneous drainage. Localized pulmonary artery compression is a rare complication of percutaneous coronary interventions (PCI). Its recognition and management are discussed, with the importance of early detection and urgent invasive management emphasized.

Résumé

Les interventions de greffe de veine saphène sont reconnues comme des procédures à risque élevé de résultats indésirables. Nous présentons un cas de rupture de greffe de veine causant un hématome focal qui a mené à une compression de l'artère pulmonaire et un choc cardiogénique sans signes classiques de tamponnade. Les images multimodalités ont révélé l'étiologie et la résolution de l'hématome après la réanimation cardiopulmonaire du patient au cours de la tentative de drainage percutané. La compression localisée de l'artère pulmonaire est une complication rare de l'intervention coronaire percutanée (ICP). Sa découverte et sa gestion sont discutées, dont l'importance d'une détection précoce et l'insistance sur la gestion des interventions effractives urgentes.

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Case Report

An 80-year-old man with a history of hypertension, dyslipidemia, type 2 diabetes, and coronary artery bypass grafting 16 years earlier presented with abdominal pain and underwent an urgent repair of an infrarenal abdominal aortic aneurysm. Ten days into an uncomplicated postoperative stay, he developed an acute coronary syndrome with new T-wave inversion in leads I and aVL, troponin I elevation to 0.3 μg/L (upper limit normal 0.04 μg/L), and new hypokinesia affecting the middle and apical

Discussion

Perforation is a rare but potentially catastrophic complication of PCI occurring in <0.5% of cases in contemporary practice. SVG PCI is recognized as being at a higher risk than arterial PCI for adverse outcomes, and limited published series report a 0.5% incidence of perforation in this group of patients.1 Rupture of SVGs has been associated with mediastinitis, bacterial infection of the vein, vein laceration secondary to trauma from the sternal edge, poor vein quality, and formation of a

Disclosures

The authors have no conflicts of interest to disclose.

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