# Iatrogenic Complete Anterolateral Papillary Muscle Rupture Following Transcatheter Gelatin Sponge Embolization for Coronary Artery Perforation

## TL;DR

A rare case of papillary muscle rupture after using gelatin sponge to stop bleeding from a coronary artery perforation is reported, leading to fatal complications.

## Contribution

First documented case of iatrogenic papillary muscle rupture following transcatheter gelatin sponge embolization for coronary artery perforation.

## Key findings

- Gelatin sponge embolization for coronary perforation can cause fatal papillary muscle rupture.
- Pathologic findings confirmed embolic material in the ruptured papillary muscle.
- The patient died despite mechanical circulatory support following mitral regurgitation.

## Abstract

Iatrogenic papillary muscle rupture (iPMR) is a rare but fatal complication of catheter interventions. No previous report to our knowledge has described iPMR with pathologic findings following transcatheter embolization for guidewire perforation of coronary artery.

An 83-year-old man with unstable angina underwent a percutaneous coronary intervention. On the same night as the percutaneous coronary intervention, a guidewire perforation of the left circumflex artery side branch was identified, resulting in cardiac tamponade. Transcatheter embolization of the culprit vessel was performed using gelatin sponge particles. Severe acute mitral regurgitation with circulatory collapse developed 30 hours later secondary to anterolateral iPMR. Despite mechanical circulatory support, the patient died 2 days after mitral regurgitation onset.

Pathologic findings revealed embolic materials within the anterolateral papillary muscle, causing new papillary muscle necrosis and rupture.

Gelatin sponge embolization may achieve hemostasis in coronary guidewire perforation but poses a significant risk of iPMR.