case_images: PMC9247988_01
case_images: Case 1: Coronary Angiography of RCA: (A) pre PCI angiogram showed severe stenosis at
  ostial-distal RPDA (black arrow), (B) contrast staining at distal RPDA (asterisk), and
  (C) angiography evaluation post pericardiocentesis showed spontaneous sealed
  perforation (yellow arrow).. Abbreviations: PCI, percutaneous coronary intervention; RPDA, right posterior
  descending artery.
case_images: 10.1177_11795468221108211-fig1.jpg
case_images: PMC9247988_01_10.1177_11795468221108211-fig1.jpg
case_images: fig1-11795468221108211
case_images: Angiography showed a patent stent in situ at LAD and LCx and severe stenosis at the ostial-distal right posterior descending artery (RPDA) (Figure 1A). Final contrast injection revealed contrast staining (Figure 1B, Supplemental Video 1) at distal RPDA. Emergent pericardiocentesis was performed, followed by angiography evaluation which showed spontaneous closure of the perforation (Figure 1C).
case_images: Case 1: Echocardiogram revealed cardiac tamponade. Echocardiography from subxiphoid
  view showed mild to moderate (8-14 mm) pericardial effusion with RV collapse (white
  arrow), pericardial clot at RV free wall (asterisk, *).. Abbreviations: LA, left atrium; LV, left ventricle; PE, pericardial effusion; RA,
  right atrium; RV, right ventricle.
case_images: 10.1177_11795468221108211-fig2.jpg
case_images: PMC9247988_01_10.1177_11795468221108211-fig2.jpg
case_images: fig2-11795468221108211
case_images: One hour after the procedure, the patient developed hypotension with echocardiography showed mild to moderate pericardial effusion with tamponade physiology and pericardial clot at right ventricle free wall (Figure 2).
case_images: Case 1: Serial ECG showed evolution and resolution of pericarditis: (A) normal sinus
  rhythm before PCI, (B) ECG 2 days post PCI showed Spodick's sign with depressed TP
  segment and ST-elevation (black arrow) at inferoanteroseptal leads, and (C) normalized
  ECG after 1-week treatment of anti-inflammatory agents.. Abbreviations: ECG, electrocardiogram; PCI, percutaneous coronary intervention.
case_images: 10.1177_11795468221108211-fig3.jpg
case_images: PMC9247988_02_10.1177_11795468221108211-fig3.jpg
case_images: fig3-11795468221108211
case_images: Emergent pericardiocentesis was performed, followed by coronary angiogram, which revealed persistent contrast leakage at distal LAD (Figure 4C, Supplemental Video 3), therefore it was decided to perform prolonged balloon inflation with a 2.0/15 mm Ikazuchi (Kaneka, Japan) semi-compliant balloon for 15 minutes (Figure 4D).
case_images: PMC9247988_02
case_images: Case 1: Serial ECG showed evolution and resolution of pericarditis: (A) normal sinus
  rhythm before PCI, (B) ECG 2 days post PCI showed Spodick's sign with depressed TP
  segment and ST-elevation (black arrow) at inferoanteroseptal leads, and (C) normalized
  ECG after 1-week treatment of anti-inflammatory agents.. Abbreviations: ECG, electrocardiogram; PCI, percutaneous coronary intervention.
case_images: 10.1177_11795468221108211-fig3.jpg
case_images: PMC9247988_02_10.1177_11795468221108211-fig3.jpg
case_images: fig3-11795468221108211
case_images: Emergent pericardiocentesis was performed, followed by coronary angiogram, which revealed persistent contrast leakage at distal LAD (Figure 4C, Supplemental Video 3), therefore it was decided to perform prolonged balloon inflation with a 2.0/15 mm Ikazuchi (Kaneka, Japan) semi-compliant balloon for 15 minutes (Figure 4D).
case_images: Case 2: Coronary angiogram: (A) pre PCI angiogram revealed LM trifurcation disease
  (black arrow), (B) contrast staining at distal LAD (yellow arrow), (C) angiogram after
  pericardiocentesis showed persistent contrast leakage (blue arrow), (D) prolonged
  balloon inflation was performed to seal the perforation, and (E) angiography
  evaluation revealed sealed perforation.. Abbreviations: LAD, left anterior descending; LM, left main; PCI, percutaneous
  coronary intervention; TIMI, thrombolysis in myocardial infarction.
case_images: 10.1177_11795468221108211-fig4.jpg
case_images: PMC9247988_02_10.1177_11795468221108211-fig4.jpg
case_images: fig4-11795468221108211
case_images: Angiogram showed severe stenosis at distal left main (Medina 1-1-1-0) moderate stenosis at ostial LAD and ostial Ramus (Figure 4A). Final contrast injection showed TIMI flow 3 with residual contrast staining (Figure 4B) at distal LAD. Emergent pericardiocentesis was performed, followed by coronary angiogram, which revealed persistent contrast leakage at distal LAD (Figure 4C, Supplemental Video 3), therefore it was decided to perform prolonged balloon inflation with a 2.0/15 mm Ikazuchi (Kaneka, Japan) semi-compliant balloon for 15 minutes (Figure 4D). Contrast injection showed sealed perforation (Figure 4E), and the patient was then stabilized.
case_images: Case 2: Echocardiogram revealed pericardial tamponade. Echocardiography from the
  parasternal short-axis view showed mild to moderate (8-18 mm) pericardial effusion
  with RV collapse (white arrow).. Abbreviations: Ao, aorta; LA, left atrium; PA, pulmonary artery; PE, pericardial
  effusion; RA, right atrium; RV, right ventricle.
case_images: 10.1177_11795468221108211-fig5.jpg
case_images: PMC9247988_02_10.1177_11795468221108211-fig5.jpg
case_images: fig5-11795468221108211
case_images: Echocardiography revealed mild-moderate pericardial effusion with tamponade signs (Figure 5).
case_images: Case 2: Serial ECG showed evolution and resolution of pericarditis: (A) sinus rhythm
  with anterior ischemia before PCI, (B) ECG 5 days post PCI showed anterior ST
  elevation (black arrow) and PR segment depression, concurrent with elevated
  inflammatory marker and normal angiogram, the diagnosis of pericarditis was made, and
  (C) normalized ECG after 1-week treatment of anti-inflammatory agents.. Abbreviations: ECG, electrocardiogram; PCI, percutaneous coronary intervention.
case_images: 10.1177_11795468221108211-fig6.jpg
case_images: PMC9247988_02_10.1177_11795468221108211-fig6.jpg
case_images: fig6-11795468221108211
case_images: Recurrent pericardial effusion was found (Supplemental Video 4) from echocardiogram with elevated inflammatory biomarkers (leucocyte 14.750/uL, C-reactive protein 4.84 mg/dL) and widespread ST elevation with PR depression at anterior leads ECG (Figure 6A and B), which confirmed the diagnosis of acute pericarditis. ECG was within the normal limit (Figure 6C), and no pericardial effusion was found on echocardiography evaluation.