Delayed ventricular septal perforation caused by minimal branches occlusion during coronary artery stenting.

A 75-year-old woman was admitted to our hospital with stable effort angina pectoris. The coronary angiogram showed 90 % stenosis at the left anterior descending artery and stenting was successfully performed. Three months later, a newly audible systolic heart murmur was heard. Computed tomography revealed a ventricular septal perforation. Coronary angiogram immediately after stenting showed major septal branch was intact but two small septal branches were occluded. In the angiography after septal perforation occurred, these small septal branches remained occluded and stent restenosis was not observed. The ventricular septal perforation was presumed to be due to occlusions of minimal septal branches.