Transient ST-segment elevation in endovascular patent foramen ovale closure: a case report

Introduction . The complication rate of endovascular patent foramen ovale (PFO) closure is considered low. However, for most of complications, the rate has not been precisely determined. The most serious intraoperative complications include damage to the heart wall and vessels with bleeding, malpositioned occlude device, thromboembolism, and air embolism. Reports of severe and potentially fatal complications are rare, making their consideration and the determination of treatment strategies crucial. Brief description . Patient K. aged 36 years had an ischemic stroke. Examination revealed a PFO with significant bypass grafting. Endovascular closure of the PFO was recommended to prevent recurrent ischemic events. During surgery, ST segment elevation was recorded in leads II and III. Selective coronary angiography revealed no contrast enhancement in the distal posterolateral and posterior descending arteries. Intracoronary nitroglycerin was administered, which restored flow in the artery. After the patient's condition stabilized, endovascular closure of the PFO was successfully completed, and an occluder was implanted. Discussion . Possible causes of intraoperative ST segment elevation include gas embolism from air bubbles remaining in the delivery system after flushing, and mechanical irritation of the interatrial septum. Preventive measures include thorough flushing of the delivery system and selection of the occluder size based on heart anatomy.