Jornal de Vasculite

Post-cardiac Injury Syndrome after Percutaneous Coronary Intervention: A Case Report

Abstract

Nassime Zaoui*, Sabrina Benamara, Amina Boukabous and Nabil Irid

Coronary angioplasty can be complicated by pericarditis which can appear at distance or more rarely early after the procedure, especially in the event of a mechanical complication of this procedure such as coronary artery perforation.

Summary of the case: We report the case of a patient who presented with early pericarditis after angioplasty complicated by coronary perforation.

It is about a 58-year-old patient admitted for angioplasty of a chronic total occlusion of the right coronary artery; the angioplasty resulted in a coronary perforation through the guidewire 0.014. The patient remained asymptomatic and hemodynamically stable. Faced with the failure to exclude the perforation by balloon inflation, we decided to perform a distal fat embolization to seal the perforation.

Twelve hours after the procedure, the patient presented with intense chest pain with a concave elevation of the ST segment in the anterior and lateral leads with an increase in troponins level and a worsening of the pericardial effusion on echocardiography motivate an emergency coronary angiography which confirms the absence of an active perforation. An elevated C-reactive protein level confirmed the diagnosis of acute pericarditis leading to the start of anti-inflammatory treatment allowing sedation of the pain, normalization of the ECG and regression of the effusion thus authorizing the patient's discharge 5 days later.

Coronary perforation during angioplasty has, in addition to these immediate hemodynamic consequences, a risk of progression to so-called traumatic acute pericarditis and should prompt rigorous monitoring of inflammatory signs and the systematic initiation of anti-inflammatory treatment (Aspirin or non-steroidal anti-inflammatory drugs and Colchicine) after the acute management of the perforation in order to reduce the long-term morbidity and mortality of this complication and the progression towards constriction.