Consult this case study on a saphenous vein graft (SVG) to right coronary artery (RCA) Type IV perforation, female 80-year old patient referred for angiogram +/- PCI.
A bedside echo ruled out pericardial effusion but did not define the fistula. Cardiac MR revealed a pseudoaneurysm arising from the right venous graft. It was compressing RV inflow at AV groove with a significant L-R shunt (1.5:1).
23 Nov 2018
Case study: a SVG to RCA Type IV perforation
Complications - Coronary perforation
Consult this case study on a saphenous vein graft (SVG) to right coronary artery (RCA) Type IV perforation, female 80-year old patient referred for angiogram +/- PCI.
Clinical presentation
Procedure
Angiography assessment
Evidence of Type IV perforation with fistula leaking into LV.
Management of perforation
A bedside echo ruled out pericardial effusion but did not define the fistula.
Cardiac MR revealed a pseudoaneurysm arising from the right venous graft. It was compressing RV inflow at AV groove with a significant L-R shunt (1.5:1).
Covered stent positioning
Covered stent implanted
Final angiographic result
Post-procedure management
Risk factors
Disclaimer
This case report does not reflect the opinion of PCR or PCRonline, nor does it engage their responsibility.
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Type I coronary perforation Type II coronary perforation Type III coronary perforation Type IV coronary perforation Type V coronary perforation Post-procedural care after coronary perforation