IMAGING IN CARDIOLOGY

Acute anteroseptal myocardial infarction

E.A. van Beek, A.J.M. Oude Ophuis

A 45-year old man was referred to our hospital with an acute anteroseptal myocardial infarction. Because of a car accident a few days before admission no thrombolysis was given and primary coronary angioplasty was performed. After initial inflation in the stenosis with a 3.5 x 18 mm balloon, rupture of the coronary artery occurred at the distal end of the balloon. The balloon was reinflated to stop the bleeding temporaryly. A Jostent GraftMaster with Hydrex Coating system 3.0 x 19 mm was implanted and successfully sealed off the ruptured coronary vessel wall. It is possible that the occlusion of the left anterior descending artery was caused by the car accident. Coronary artery occlusion is a rare complication of blunt chest trauma. The left anterior descending artery is the injured vessel in 76%, followed by the right coronary artery (12%) and the circumflex coronary artery (6%).' Most likely the occlusion is a thrombotic response to an intimal tear caused by the trauma.2

Fukutomi et al. find 69 coronary perforations in 7443 PCI's. 18 have a jet of contrast extravasation and those were all treated by prolonged perfusion balloon angioplasty. 2 required emergency coronary artery E.A. van Book Department of Cardiology, Nijmegen University Medical Centre,

Nijmegen A.J.M. Oude Ophuls Department of Cardiology, Canisius Wilhelmina Medical Centre, Nimegen

Correspondence to: E.A. van Beek Department of Cardiology, Nijmegen University Medical Centre, Nijmegen E-mail: [email protected]

508

Figure 1. Left anterior oblique view of the left anterior descending artery. Clearly visible is the bilateral outflow of contrast in the middle segment.

bypass surgery and 72,2% developed late pseudoaneurysms within one year but without consequences.3 The incidence is low, 0,1-0,2% with balloon angioplasty alone but when atherectomy devices are used the incidence rises to 2%.4 Smaller perforations like most guidewire perforations may be treated with observation or prolonged balloon inflation. Larger perforations require quick balloon tamponade before other treatments are performed, for example reversal of anticoagulation, intravenous fluids, pericardiocentesis, surgical exploration or covered stents.5 Pericardiocentesis should be performed only in

Netherlands Heart Journal, Volume 12, Number 11, November 2004

IMAGING IN CARDIOLOGY

hemodynamic unstable patients rather than on a prophylactic basis. References 1 2

3 4

5

Ginzburg E, Dygert J, Parra-Davila E, Lynn M, Almeida J, Mayor M. Coronary artery stenting for occlusive dissection after blunt chest trauma. J Trauma 1998;45:157-61. Oren A, Bar-Sholomo B, Stern S. Acute coronary occlusion following blunt injury to the chest in the absence of coronary atherosclerosis. Am HeartJ1976;92:501-5. Fukutomi T, Suzuki T, Popma JJ, et al. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. CircJ2002;66(4):349-56. Ellis SG, S Ajluni, AZ Arnold, et al: Increased coronary perforation in the new device era: incidence, classification, management, and outcome. Circulation 1994;90:2725-30. Gruberg L, E Pinnow, RFlood, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology 2000; 86:680-2.

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In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands. This section is edited by M.J.M. Cramer andj. Bax.

Productinformatie van de in dit tijdschrift opgenomen advertenties Referenties: 1. Sega R., et al. Efficacy and safety of eprosartan in severe hypertension. Blood Pressure 1999; 8: 114-121. 2. Sachse et al. Efficacy of eprosatan in combination with HCTZ in patents with essential hypertension. J of Human Hypertension, 2002, 16: 169-176.

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Acute anteroseptal myocardial infarction.

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