PMC10280286_01
Right ventricular branch perforation during right coronary artery percutaneous coronary intervention. (A) Ellis classification type II microchannel perforation during right ventricular branch wiring (arrow) (B) Balloon tamponade at the perforated right ventricular branch (arrow) (C) Percutaneous coronary intervention at the right coronary artery chronic total occlusion (D) Final angiography without residual extravasation at the perforation site.
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F1
PCI at the RCA CTO lesion was complicated by Ellis classification type II microchannel perforation during right ventricular (RV) branch wiring proximal to the lesion for additional support during CTO wiring (Figure 1). Intraventricular septal bouncing and respiratory mitral and tricuspid valve inflow variability suggested constrictive pericarditis (Figure 2, Supplementary Video S1).
Echocardiogram showing pericardial effusion and constrictive physiology. Small amount of pericardial effusion and thickened pericardium in (A) parasternal long axis view and (B) modified 4-chamber view. Annulus inversus findings showing (D) decreased lateral e' velocity compared to (C) septal e' velocity. (E) Mitral inflow showing significant variations during respiration (F) Plethoric inferior vena cava during inspiration.
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F2
Intraventricular septal bouncing and respiratory mitral and tricuspid valve inflow variability suggested constrictive pericarditis (Figure 2, Supplementary Video S1).
(A) Pericardial effusion, pleural effusion, and (B) ascites on computed tomograph, (C) intraoperative findings: thickened pericardium and hemopericardium.
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F3
LVEF of 39%. Large amounts of pleural effusion and ascites were apparent on CT scans of the chest and abdomen, the latter of which was identified as transudate by paracentesis (Figures 3A,B). Intraoperative findings revealed a thickened (5 mm) and slightly adhesive pericardium without calcifications, and a dark bloody effusion was drained after opening of the pericardium (Figure 3C).