Xiao-Lin Yu, Ji-Jiang Huang, Xiang-Yu Dong, Fan Luo, Zi-Long Zhang, Zhao Wang, Guo-Qing Li, Yi-Ning Yang
Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China; Xinjiang Key Laboratory of Cardiovascular Homeostasis and Regeneration Research, Urumqi, China.
Xinjiang Key Laboratory of Cardiovascular Homeostasis and Regeneration Research, Urumqi, China; Department of Echocardiography, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
JACC Case Rep. 2025 Jul 30;30(21):104348. doi: 10.1016/j.jaccas.2025.104348.
This case report describes the emergency management of a 70-year-old man who developed acute cardiac tamponade owing to right coronary artery rupture during chronic total occlusion percutaneous coronary intervention. Despite successful covered stent deployment and pericardiocentesis, iatrogenic right ventricular perforation occurred owing to a misplaced pericardial sheath. A novel dual-device strategy combining ProGlide and StarClose (Abbott) SE vascular closure devices achieved complete hemostasis under real-time transthoracic echocardiography and digital subtraction angiography. Key innovations include the first hybrid vascular closure device application for right ventricular perforation, synchronized pericardial drainage, and protocolized autotransfusion. This approach challenges surgical paradigms, demonstrating percutaneous bailout feasibility for complex iatrogenic injuries. Sustained procedural success was confirmed at 30-day follow-up.
本病例报告描述了一名70岁男性在慢性完全闭塞经皮冠状动脉介入治疗期间因右冠状动脉破裂导致急性心脏压塞的紧急处理情况。尽管成功植入覆膜支架并进行了心包穿刺引流，但由于心包穿刺鞘位置不当，仍发生了医源性右心室穿孔。一种结合使用ProGlide和StarClose（雅培）SE血管闭合装置的新型双装置策略在实时经胸超声心动图和数字减影血管造影引导下实现了完全止血。关键创新包括首次将混合血管闭合装置应用于右心室穿孔、同步心包引流以及规范化自体输血。这种方法挑战了外科手术模式，证明了对复杂医源性损伤进行经皮补救的可行性。30天随访证实手术持续成功。
