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A large dissecting sub-epicardial hematoma and cardiac tamponade following elective percutaneous coronary

Kazunori Kashiwase1, Yasunori Ueda, Nobuyuki Ogasawara

  • 1Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennohji-ku, Osaka City, Osaka 543-0035, Japan. kassy@oph.gr.jp

Journal of Cardiology
|October 17, 2008
PubMed

Insights

A rare case of cardiac tamponade after percutaneous coronary intervention led to emergent surgery and death. Autopsy revealed an intramural hematoma, with no evidence of coronary perforation or rupture.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery stenosis.
  • Complications, though rare, can include cardiac tamponade and myocardial injury.
  • Prompt diagnosis and management are crucial for patient outcomes.

Observation:

  • A 70-year-old woman developed cardiac tamponade immediately following PCI of the 1st diagonal branch.
  • Emergent cardiac surgery revealed a large epicardial hematoma compressing the distal diagonal branch.
  • The patient subsequently died from multi-organ failure.

Findings:

  • Autopsy demonstrated an extensive intramural hematoma within the left ventricular wall.
  • Crucially, there was no evidence of perforation or rupture at the stented lesion site.
  • The cause of the hematoma was not attributed to coronary perforation or target lesion rupture.

Implications:

  • This case highlights a potential, non-perforation-related mechanism for intramural hematoma formation after PCI.
  • It underscores the importance of considering alternative etiologies for cardiac tamponade post-PCI.
  • Further investigation into the pathophysiology of such intramural hematomas is warranted.

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