Left Ventricular Free-Wall Injury During Emergency Pericardial Drainage After Percutaneous Coronary Intervention-Related Coronary Perforation.
Quan Zuo, Tao Ge, Jichun Liu et al.
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Case in brief
A 63-year-old woman developed shock and an enlarging pericardial effusion after PCI for a severely calcified right coronary artery lesion complicated by perforation, which was sealed with a covered stent. Echocardiography-guided apical pericardiocentesis initially improved her condition, but bloody drainage continued, with recurrent hypotension and a marked hemoglobin fall. Repeat coronary angiography showed no recurrent leak; imaging instead revealed an abnormal catheter trajectory. Emergency surgery confirmed penetration of the left ventricular free wall. The catheter was removed after surgical repair, and the patient recovered well.
What made this case unusual
Persistent bloody drainage was initially a potential clue to ongoing coronary leakage, but the actual source was pericardial-drain catheter penetration of the left ventricular free wall.
Diagnostic / clinical pearl
When bloody pericardial drainage and shock persist after coronary perforation has been sealed, reassess drain position promptly; consider catheter-related cardiac injury and remove a potentially malpositioned catheter only in a controlled setting.