Managing low profile - left main transmural laceration

Perforation of the left main stem is a rare complication associated with combined aortic valve replacement and by-pass surgery. One-year following aortic valve replacement a 70-year-old male presented with chest pain. This was related to a slowly expanding haematoma caused by a low profile chronic perforation of the left main. Subsequently, a tailored percutaneous modification of the main stem was performed. At three months follow-up, he had no complaints and selective coronary angiography confirmed the successful sealing of the perforation with a concomitant regression of the prior haematoma.