Januszek Rafał, Bartuś Krzysztof, Litwinowicz Radosław, Dziewierz Artur, Rzeszutko Łukasz
2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland.
Open Cardiovasc Med J. 2017 Jun 19;11:61-65. doi: 10.2174/1874192401711010061. eCollection 2017.
Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments.
We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement.
This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.
冠状动脉穿孔（CAP）是经皮冠状动脉介入治疗（PCI）的一种并发症。已表明亲水导丝会增加CAP的发生概率。根据穿孔大小，我们采用不同的治疗方法。
我们报告一例73岁男性患者，患有冠状动脉疾病和严重主动脉瓣狭窄。该患者正在接受经导管主动脉瓣植入术的评估。不幸的是，在PCI过程中发生了左前降支第一对角支的CAP。最初，心包腔内的急性出血得到了初步控制。然而，在接下来的几天里，心包出血变得隐匿、持续，最终导致了外科心包切开术和外科主动脉瓣置换术。
该病例表明，在某些情况下，急性期对CAP进行更积极的血管内治疗可降低未来进行根治性手术治疗的可能性。尽管在其他情况下，避免对CAP进行根治性血管内治疗以及动脉分布沿线的继发性坏死会导致更高的转为心脏外科手术的风险。对CAP严重程度进行准确的初步评估并在PCI后进行仔细观察可改善治疗结果并避免严重并发症。
