Cardiac tamponade following percutaneous transluminal coronary angioplasty: Four case reports

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) has had complications related to dilating catheters and guide wires such as coronary artery dissection, spasm, rupture, and perforation. This report describes four patients who developed cardiac tamponade following PTCA, presumably from right ventricular (RV) perforation. All four received large doses of heparin during PTCA and three received antiplatelet therapy. In three cases, cardiac tamponade occurred several hours after PTCA. All patients did well following operative intervention and no patient required repair of a cardiac perforation. We postulate that impaired hemostasis in the presence of an otherwise inconsequential RV perforation causes tamponade. Three alternatives to provide standby pacing are proposed.

Myocardial perforation in the cardiac catheterization laboratory: incidence, presentation, diagnosis, and management

“…Although we experienced no perforation during 167 right ventricular endomyocardial biopsies, this is not inconsistent with the expected rate of 0.42% 121-231. Cardiac perforations and tamponade in association with conventional coronary angioplasty are usually due to right ventricular perforation by a temporary pacing catheter rather than coronary arterial disruption [24,25], although balloon rupture of both native vessels and saphenous vein grafts has been reported [26,27]. In fact, our single perforation during a coronary angioplasty procedure (atherectomy) occurred as a result of right ventricular perforation by a temporary pacing catheter.…”

Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction

“…In the presented case, a type III perforation occurred immediately after emergency balloon angioplasty in acute anterior myocardial infarction. In contrast to acute perforations, in rare cases the perforation occurs later, 30 min up to 7 hr after balloon angioplasty, and is detected due to hemodynamic deterioration [34,73]. …”

“…In most patients, however, coronary perforation after balloon angioplasty results in pericardial effusion and cardiac tamponade, which often needs pericardial drainage, immediate surgery, or both [29,34,59,60,65,66,[68][69][70][71]73]. After coronary perforations using balloon angioplasty or new devices, cardiac tamponade occurs in 8% after type I, in 13% after type II, and in 63% after type III perforation [8,10].…”

“…If contrast dye drains into a cardiac cavity, such as ventricle or coronary sinus, the subtype CS for cavity spilling is discriminated. Type IIICS perforation into right [28,[33][34][35] or left ventricle [36][37][38], right atrial space [39], or coronary sinus [40] are rare complications.…”

Successful coronary pace-termination of ventricular tachycardia during coronary angioplasty

“…The patient was discharged well the next day. [1] first described the technique of coronary pacing during PTCA to avoid additional venous puncture and the associated complications of transvenous pacing wires [2][3][4][5][6]. The value of the technique was further demonstrated prospectively in a group of 300 patients undergoing PTCA by de la Serna et al [7]: 7 patients (2%) required pacing for bradycardias but not for tachycardias.…”