Percutaneous aortic valve replacement in an 86-year-old female patient with severe symptomatic aortic valve stenosis was complicated by occlusion of the left main coronary artery. The patient presented with marked hypotension and chest pain. Flow was re-established after the introduction of a guidewire and implantation of a drug-eluting stent at the site of the occlusion. Figure 1 and figure 2 show the traces before and after the procedure, respectively. The changes observed in figure 2 resolved in a few hours.

Figure 1

(0.54MB).

Figure 2

(0.45MB).

What does figure 2 show?

• 1.

  Acute pulmonary embolism

• 2.

  Pre-excitation via a left lateral accessory pathway

• 3.

  Inferolateral infarction

• 4.

  Left septal fascicular block

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