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Myocardial Hematoma Documented by Transthoracic Echocardiography After Sequential Coronary Artery Stenting
Deepak Banerjee1, Michele Venezia, Angel López-Candales
1The Buffalo General Hospital, Cardiology Division, Room B609, Buffalo, NY 14203.
Insights
A patient experienced sudden deterioration during coronary artery stenting. Transthoracic echocardiography revealed a myocardial hematoma and pericardial effusion, leading to emergency surgery and successful recovery. Early echocardiography aids in recognizing such complications.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Endoluminal coronary artery reconstruction, particularly with multiple stents in the left anterior descending artery, carries inherent risks.
- Sudden patient deterioration during such procedures necessitates rapid diagnostic assessment and intervention.
Purpose of the Study:
- To report a rare case of ventricular wall dissection and myocardial hematoma during coronary artery reconstruction.
- To highlight the crucial role of transthoracic echocardiography in the early diagnosis of this complication.
- To discuss potential contributing factors and management strategies.
Main Methods:
- A case report detailing a patient undergoing endoluminal coronary artery reconstruction.
- Utilization of transthoracic echocardiography for diagnosis.
- Emergency surgical exploration and coronary artery bypass graft surgery.
Main Results:
- Sudden deterioration occurred during stenting of the left anterior descending coronary artery.
- Transthoracic echocardiography identified a pericardial effusion and a significant myocardial hematoma with ventricular wall dissection.
- Emergency surgical intervention successfully evacuated the hematoma and was combined with coronary artery bypass grafting.
Conclusions:
- Myocardial hematoma and ventricular dissection are rare but critical complications of coronary artery reconstruction.
- Transthoracic echocardiography is invaluable for prompt diagnosis of these intraprocedural emergencies.
- Multidisciplinary management involving interventional cardiology and cardiac surgery is essential for favorable outcomes.
Abstract:
We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition.