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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Management of a left atrial intramural hematoma after percutaneous intervention

Anand Jothidasan1, Saina Attaran1, David Hunter2

  • 1Cardiothoracic Department, Royal Brompton Hospital, Imperial College, London, United Kingdom.

The Annals of Thoracic Surgery
|June 3, 2014
PubMed

Insights

A rare complication of percutaneous intervention, left atrial intramural hematoma, occurred in a patient. Successful drainage via thoracotomy, guided by transesophageal echocardiography, resolved the critical cardiac obstruction.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous coronary intervention (PCI) carries risks, including rare but serious complications.
  • Left atrial intramural hematoma is an uncommon event following invasive cardiac procedures.
  • Recurrent angina post-coronary artery bypass grafting (CABG) necessitates careful management and intervention.

Observation:

  • A 69-year-old male presented with recurrent angina post-CABG.
  • During PCI, the patient experienced cardiac arrest after attempted recanalization of a native artery and vein graft.
  • Transesophageal echocardiography revealed a large left atrial intramural hematoma obstructing the mitral valve and compressing the right atrium.

Findings:

  • The left atrial intramural hematoma was successfully diagnosed using transesophageal echocardiography.
  • Emergency thoracotomy was performed for hematoma drainage.
  • The procedure was guided by transesophageal echocardiography, confirming successful hematoma evacuation.

Implications:

  • This case highlights the importance of recognizing and managing rare complications of PCI.
  • Transesophageal echocardiography is crucial for diagnosing and guiding treatment of left atrial intramural hematoma.
  • Prompt surgical intervention can be life-saving in cases of significant cardiac compression due to intramural hematoma.

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