Great cardiac vein injury after circumflex artery intervention: a case report

Abstract

Background Injury of the great cardiac vein during circumflex coronary artery intervention is not discussed enough in the literature. In addition, relationship between the great cardiac vein and circumflex artery is highly variable and practically unpredictable in 30% of cases. This report describes a rare case of great cardiac vein injury during circumflex artery intervention. Case Presentation An 80-year-old man with known ischemic heart disease was admitted with instable anginal pain for urgent coronary angiography. Cx-PCI of proximal-to-medial high-grade calcified stenosis was performed. Two hours later, the patient developed pericardial tamponade. Pericardiocentesis revealed a venous bloody effusion. Due to continuous bleeding, an urgent exploratory thoracotomy was performed. Intraoperatively, a large pericardial hematoma in the Cx region was evacuated. The perforation site was sought and identified as a tear at the great cardiac vein. Further hospitalization was uneventful, and the patient was discharged after one week. Clinical and echocardiographic outcomes were favorable at the 3-month follow-up. Conclusion A great cardiac vein injury during percutaneous coronary intervention is a diagnosis of exclusion if there is a venous pericardial effusion directly after PCI and no injury of the right ventricle or surrounding structures and thoracic CT demonstrates a pericardial hematoma in the PCI region, especially the Cx region. A hematoma can deteriorate the hemodynamic status without effusion “dry tamponade”. Treatment should be addressed according to hemodynamics. A conservative therapy, pericardiocentesis, catheter-based bailout intervention or even an explorative pericardiotomy could be imperative to evacuate the hematoma and seal the injured vein.