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Case Reports
. 2021 Jan 28;21(1):55.
doi: 10.1186/s12872-021-01875-0.

Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

Daisuke Kanda  1 , Takuro Takumi  2 , Takeshi Sonoda  2 , Ryo Arikawa  2 , Kazuhiro Anzaki  2 , Yuichi Sasaki  2 , Mitsuru Ohishi  2
Affiliations
Case Reports

Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

Daisuke Kanda et al. BMC Cardiovasc Disord. .

Abstract

Background: Pericardiocentesis is frequently performed when fluid needs to be removed from the pericardial sac, for both therapeutic and diagnostic purposes, however, it can still be a high-risk procedure in inexperienced hands and/or an emergent setting.

Case presentation: A 78-year-old male made an emergency call complaining of the back pain. When the ambulance crew arrived at his home, he was in a state of shock due to cardiac tamponade diagnosed by portable echocardiography. The pericardiocentesis was performed using a puncture needle on site, and the patient was immediately transferred to our hospital by helicopter. Contrast-enhanced computed tomography showed a small protrusion of contrast media on the inferior wall of the left ventricle, suggesting cardiac rupture due to acute myocardial infarction. Emergency coronary angiography was then performed, which confirmed occlusion of the posterior descending branch of the left circumflex coronary artery. In addition, extravasation of contrast medium due to coronary artery perforation was observed in the acute marginal branch of the right coronary artery. We considered that coronary artery perforation had occurred as a complication of the pericardial puncture. We therefore performed transcatheter coil embolization of the perforated branch, and angiography confirmed immediate vessel sealing and hemostasis. After the procedure, the patient made steady progress without a further increase in pericardial effusion, and was discharged on the 50th day after admission.

Conclusions: When performing pericardial drainage, it is important that the physician recognizes the correct procedure and complications of pericardiocentesis, and endeavors to minimize the occurrence of serious complications. As with the patient presented, coil embolization is an effective treatment for distal coronary artery perforation caused by pericardiocentesis.

Keywords: Cardiac tamponade; Coil embolization; Coronary artery perforation; Pericardiocentesis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography at the focus of left ventricle. Contrast-enhanced computed tomography shows partial protrusion of contrast medium from the inferior wall of the left ventricle (a) and poor enhancement of the inferior wall (b)
Fig. 2
Fig. 2
Pericardiocentesis and puncture needle. Computed tomography shows the tip of the outer cannula of the puncture needle in the pericardial cavity (a–c). Needle used for pericardiocentesis (d)
Fig. 3
Fig. 3
Coronary angiography and coil embolization. Left coronary angiography reveals occlusion of the posterior descending branch of the left circumflex coronary artery (a, b). Right coronary angiography shows extravasation of contrast medium in the acute marginal branch of the right coronary artery (c), and confirms sealing of the perforated artery following coil embolization (d). CAU caudal oblique, CRA cranial oblique, LAO left anterior oblique, RAO right anterior oblique
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