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Cardiogenic shock without cardiac tamponade caused by a subepicardial hematoma after percutaneous coronary

Masato Furui1, Takeki Ohashi, Takeshi Yoshida

  • 1Cardiovascular Surgery Department, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan.

General Thoracic and Cardiovascular Surgery
|February 11, 2011
PubMed

Insights

A rare case of subepicardial hematoma causing cardiogenic shock during percutaneous coronary intervention (PCI) is presented. Decompression of the hematoma via pericardiotomy successfully treated the patient.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery stenosis.
  • Coronary artery rupture is a rare but serious complication during PCI.
  • Cardiogenic shock can occur due to various cardiac events, including complications from PCI.

Observation:

  • A 73-year-old male developed sudden shock during PCI for severe right coronary artery stenosis.
  • Initial percutaneous pericardiocentesis relieved cardiac tamponade, but shock persisted.
  • Emergency surgery revealed a large subepicardial and intramyocardial hematoma compressing the heart.

Findings:

  • The persistent shock was attributed to a subepicardial hematoma, not cardiac tamponade.
  • Pericardial incision and off-pump coronary artery bypass grafting were performed.
  • Decompression of the subepicardial hematoma by pericardiotomy led to clinical improvement.

Implications:

  • This case highlights a rare cause of cardiogenic shock following PCI.
  • Subepicardial hematoma should be considered in patients with persistent shock after PCI, even without tamponade.
  • Prompt surgical decompression of subepicardial hematomas is crucial for patient survival.

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