Transcatheter Management of Iatrogenic Right Ventricular Perforation During Salvage Coronary Intervention

This case report describes the emergency management of a 70-year-old man who developed acute cardiac tamponade owing to right coronary artery rupture during chronic total occlusion percutaneous coronary intervention. Despite successful covered stent deployment and pericardiocentesis, iatrogenic right ventricular perforation occurred owing to a misplaced pericardial sheath. A novel dual-device strategy combining ProGlide and StarClose (Abbott) SE vascular closure devices achieved complete hemostasis under real-time transthoracic echocardiography and digital subtraction angiography. Key innovations include the first hybrid vascular closure device application for right ventricular perforation, synchronized pericardial drainage, and protocolized autotransfusion. This approach challenges surgical paradigms, demonstrating percutaneous bailout feasibility for complex iatrogenic injuries. Sustained procedural success was confirmed at 30-day follow-up.