Aortic perforation as a complication of percutaneous coronary angiography

SummaryAortic perforation during coronary angiography is a rare but potentially lethal complication. We present the case of a 75-year-old man who sustained an aortic perforation at the sinus of Valsava during coronary angiography being carried out in preparation for percutaneous coronary intervention (PCI). This clinical emergency was initially managed by pericardiocentesis with a pigtail catheter, despite subtle evidence shown by the image of coronary perforation or aortic perforation. Emergency pericardiotomy was performed and active bleeding was found from the sinus of Valsava. We successfully repaired the perforation using a direct tensionless suture. This case suggests that aortic perforation can be missed if there is only a subtle contrast jet in the angiography, and emergency surgical intervention will then become mandatory