Vol 79, No 5 (2021)
Clinical vignette
Published online: 2021-06-08

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  • „ CLINICAL VIGNETTE

Surgical revascularization in STEMI patient after failed percutaneous coronary interventions with broken angioplasty wire protruding into the aortic root

Tomasz Urbanowicz1, Bartłomiej Perek1, Anna Olasińska-Wiśniewska1, Włodzimierz Skorupski2, Marek Jemielity1

1Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznań, Poland

21st Cardiology Department, Poznan University of Medical Sciences, Poznań, Poland

Correspondence to:

Tomasz Urbanowicz, MD, PhD,

Cardiac Surgery and Transplantology Department,

Poznan University of Medical Sciences,

Długa 1/2, Poznań, Poland,

e-mail: tomasz.urbanowicz @skpp.edu.pl

Copyrighy by the Author(s), 2021

Kardiol Pol. 2021; 79 (5): 579–580; DOI: 10.33963/KP.15880

Received: December 7, 2020

Revision accepted: March 2, 2021

Published online: March 16, 2021

Percutaneous coronary interventions (PCI) have an established position in the management of patients presenting with acute coronary syndromes [1]. Rare, but serious adverse events may be related to stents/wire distortions [2, 3].

We present a case of a 67-year-old male who was admitted to a hospital with anterior wall ST-elevation myocardial infarction. Urgent coronary catheterization revealed left anterior descending artery (LAD) occlusion close to diagonal branch origin (Figure 1A).

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Figure 1. A. Angiography of acute left descending artery occlusion with metallic coil of the guidewire left in the proximal part. B. Right coronary artery angiography. C. Intraoperative view into aortic root with metallic coil. D. 7 cm long metallic coil removed from the aortic lumen

Middle segments of circumflex (CX) and right coronary (RCA) arteries were also significantly stenotic (Figure 1B). The heart team decided to perform emergent LAD angioplasty.

The bolus of 7.9 ml of INN-eptifibatide was administrated and followed by continuous infusion with a 14 ml/h rate. The drug-eluting sent (Xience 3.0 × 28 mm) was implanted into LAD. The drug-eluting sent (Xience 3.0 × 28 mm) was implanted into LAD. After stent implantation, a part of the wire was entrapped in the coronary artery. The metallic coil covering the core of the angioplasty wire was left in the proximal part of LAD and protruded into the aortic root.

The patient was referred for emergency surgery. The procedure was performed through median sternotomy in cardiopulmonary bypass. After transverse aortotomy, the aortic root lumen was inspected, and the metallic coil was localized (Figure 1C). As the foreign body of 7 cm in length was irremovable, it was transected and left in the proximal portion of the left main coronary artery (Figure 1D). The operators decided to perform revascularization of LAD, CX, and RCA. The saphenous vein bypass grafts (SVBG) were performed into CX and RCA and the left internal mammary (LIMA) was anastomosed into LAD with continuous 7-0 monofilament suture. The estimated blood flow was 7 ml/min with pulsation index (PI) of 3.4 in LIMA-to-LAD 39 ml/min with PI 1.3 in SVBG-to-CX and 43 ml/min with PI 1.1 in SVBG-to-RCA grafts, respectively.

The surgical approach allows achieving complete revascularization in acute coronary syndromes. Postoperative bypass blood flow measurements provide significant information about the quality of performed anastomoses.

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REFERENCES

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Polish Heart Journal (Kardiologia Polska)