Intractable Pulmonary Edema After PCI: An Extremely Rare Iatrogenic Mechanical Cause.

BACKGROUND

Permanent aortic valve injury following percutaneous coronary intervention (PCI) is a rare but catastrophic complication that can cause acute severe aortic regurgitation (AR) and heart failure.

CASE SUMMARY: A 49-year-old man developed recurrent acute pulmonary edema after a failed staged PCI for chronic total occlusion of the left anterior descending artery. Transthoracic echocardiography revealed severe eccentric AR caused by a 7-mm injury to the noncoronary cusp and left cusp confirming iatrogenic cusp laceration. He underwent successful surgical repair with pericardial patch reconstruction and coronary artery bypass grafting, with excellent recovery.

DISCUSSION: Literature on catheter-induced aortic valve injury is sparse. This case highlights a rare cause of post-PCI shock where prompt echocardiography guided lifesaving surgical intervention.

TAKE-HOME MESSAGES: Not all post-PCI cardiac decompensation is ischemic. Severe AR from iatrogenic aortic cusp injury, though rare, should be promptly excluded.