Acute ST-Segment Elevation Myocardial Infarction as a Rare Postoperative Complication of Biventricular Implantable Cardioverter-Defibrillator Placement

Figures

• 

  Figure 1. Electrocardiogram Showing Acute ST-Segment Elevation Myocardial Infarction Post–Implantable Cardioverter-Defibrillator Placement An electrocardiogram obtained for acute chest pain after placement of the implantable cardioverter-defibrillator showing ST-segment elevation in leads I, aVL, V5, and V6, with reciprocal ST-segment depressions in V1 through V4.

• 

  Figure 2. First Angiogram Showing Completely Occluded Second Obtuse Marginal Artery (A) Right anterior oblique caudal view. (B) Right anterior oblique cranial view. These images show the results of the first angiography after acute ST-segment elevation myocardial infarction post-implantable cardioverter-defibrillator placement in 2 different views. There is a 100% distal occlusion of the second obtuse marginal artery (red arrows), which corresponded to an anchoring mechanism of the left ventricle lead (orange arrows). The white arrow points to the right ventricular lead.

• 

  Figure 3. First Angiogram Showing Restoration of Flow in the Second Obtuse Marginal Artery The results of the first coronary angiography after the second obtuse marginal artery lesion was negotiated with a coronary wire and a microcatheter. Without further intervention, an angiogram demonstrated restoration of flow distally in the obtuse marginal artery (red arrow). The orange arrow points to the left ventricle lead.

• 

  Figure 4. Second Angiogram Showing Completely Reoccluded Second Obtuse Marginal Artery Second angiogram as a part of the hybrid procedure before the unscrewing of the left ventricle lead (orange arrow) showed a complete reocclusion of the second obtuse marginal artery (red arrow).

• 

  Figure 5. Post-Hybrid Procedure Angiogram Showing No Residual Stenosis in the Second Obtuse Marginal Artery Flow through the second obtuse marginal artery improved as the fixation mechanism on the left ventricle lead (orange arrow) was released and the lead was pulled back. An area of focal stenosis in the second obtuse marginal artery was dilated with a balloon. A repeat angiogram immediately postangioplasty showed no residual stenosis in the second obtuse marginal artery (red arrow).