EMERGENCY SURGICAL REPAIR OF AN IATROGENIC CORONARY SINUS INJURY CAUSING CARDIAC TAMPONADE DURING IMPLANTABLE CARDIOVERTER - DEFIBRILLATOR IMPLANTATION: A CASE REPORT
11th INTERNATIONAL CONFERENCE ON MULTIDISCIPLINARY SCIENTIFIC STUDIES , İstanbul, Turkey, 15 - 16 August 2026, pp.805-809, (Full Text)
- Publication Type: Conference Paper / Full Text
- City: İstanbul
- Country: Turkey
- Page Numbers: pp.805-809
- Open Archive Collection: AVESIS Open Access Collection
- Recep Tayyip Erdoğan University Affiliated: Yes
Abstract
ABSTRACT Introduction: Cardiac implantable electronic device (CIED) procedures are performed with increasing frequency in patients with heart failure with reduced ejection fraction. Although generally safe, these procedures carry a small but important risk of cardiac perforation, and injury to the thin-walled coronary sinus is a rare complication that may progress rapidly to cardiac tamponade and circulatory collapse. Case Presentation: A 59-year-old woman who had presented with dyspnea and had been diagnosed with heart failure approximately one month earlier (left ventricular ejection fraction 30%, atrial fibrillation) underwent transvenous implantable cardioverter-defibrillator (ICD) implantation for the primary prevention of sudden cardiac death. During the procedure her hemodynamic status deteriorated abruptly; immediate bedside echocardiography revealed a pericardial effusion with tamponade physiology, and an iatrogenic coronary sinus injury was suspected. She was transferred emergently to the operating room. Through a classic median sternotomy the pericardial hematoma was evacuated and the coronary sinus laceration was identified and repaired primarily with pledgeted sutures. The repair was completed on the beating heart without the need for cardiopulmonary bypass, achieving complete hemostasis. The postoperative course was uneventful and the patient was discharged in good condition. Device implantation was deferred and is planned during outpatient follow-up. Conclusion: Coronary sinus injury is a rare but potentially fatal complication of transvenous device implantation. Prompt bedside echocardiographic recognition of tamponade, immediate transfer to surgery, and off-pump repair with pledgeted sutures — which distribute tension across the fragile, thin walled venous tissue — can be life-saving and avoid the added morbidity of cardiopulmonary bypass. This case underscores the importance of readily available cardiac surgical backup wherever CIED procedures are performed. Keywords: cardiac tamponade; coronary sinus; implantable cardioverter-defibrillator; iatrogenic injury; off-pump repair; pledgeted suture