Successful surgical management of coronary perforation requiring pulmonary artery separation.

A 73-year-old woman with type III coronary perforation caused by failed angioplasty underwent emergency operation. It was impossible to stop the bleeding from the beating heart because the proximal Cx, which was the perforation site, was behind the main pulmonary artery. After establishing cardiopulmonary bypass, we separated the main pulmonary artery to secure hemostasis and performed coronary artery bypass grafting to the distal Cx. The postoperative course was uneventful therefore the patient was discharged on the tenth postoperative day. Surgical strategies are not standardized for coronary perforation and depend mainly on the surgical anatomy. In a situation like the present, which appears not to have been described previously, it is important to save the life of the patient by whatever means.