Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires

Rafał Januszek1, *, Krzysztof Bartuś2, Radosław Litwinowicz2, Artur Dziewierz1, 3, Łukasz Rzeszutko1, 4
1 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
2 Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
3 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
4 Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland

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© 2017 Januszek et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, ul. Kopernika 17, 31-501 Kraków, Poland; Tel: +48 12 424 71 70; Fax: +48 12 424 71 80; E-mail:



Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments.


We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement.


This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.

Keywords: Coronary artery perforation, Hydrophilic guide-wires, Cardiac tamponade, Pericardiotomy.