[Non-surgical management of a perforated left anterior descending coronary artery following cardiopulmonary resuscitation].

UNLABELLED: A 49 year old male developed cardiocirculatory arrest following laparoscopic surgery of an inguinal hernia. Cardiopulmonary resuscitation (CPR) was started. The primary ECG showed ventricular fibrillation, after defibrillation a tachyarrhythmia and a newly developed right bundle branch block were documented. In addition, ST-elevations were seen in the left precordial leads. After 20 min of CPR the circulation was reestablished with high doses of catecholamines. Transthoracic echocardiography demonstrated a 7 mm pericardial effusion with mild impression of the right ventricular free wall. The patient underwent urgent heart catheterization for suspected pulmonary embolism (differential diagnosis: acute myocardial infarction). Pulmonary angiography demonstrated floating thrombi in the left main pulmonary artery, which could be fragmented using a pigtail catheter. Pulmonary angiography was followed by coronary angiography, which demonstrated a sharply interrupted left anterior descending artery (LAD), while the coronary arteries in general were found to be regular. The history, the morphology of the LAD-interruption, the concomitant pericardial effusion and the sternal and rib fractures were consistent with a type III coronary perforation in the classification of Sutton and Ellis. As contrast medium penetration into the pericardial space persisted after recanalization of the LAD, a 19 mm stent graft (Jostent) was used for closure. These grafts are constructed using a sandwich technique with an ultrathin layer of expandable polytetrafluorethylene being placed between two stents. After implantation of the stent graft no more contrast medium penetration was documented.

CONCLUSION

Coronary perforations following blunt chest trauma is a rare complication, which has been described only once following CPR (2). Stent grafts can be used safely for acute closure of such perforations.