Cardiovascular collapse post chronic total occlusion percutaneous coronary intervention due to a compressive left...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure.
• Retrograde CTO PCI using epicardial collaterals can be challenging.
• Patients with prior cardiac surgery may have altered anatomy, increasing procedural risk.

Observation:

• A patient developed hypotension following CTO PCI.
• The patient had undergone previous cardiac surgery.
• Hypotension was attributed to a left atrial hematoma causing chamber compression, resulting from coronary perforation during PCI.

Findings:

• This case represents the first description of successful non-surgical management of a left atrial hematoma causing cardiovascular collapse.
• Percutaneous drainage was employed for the hematoma.
• The patient's cardiovascular status improved following the drainage procedure.

Implications:

• Coronary perforation is a recognized complication of PCI, potentially leading to life-threatening conditions like cardiac tamponade or chamber compression.
• Hypotension post-CTO PCI in patients with prior cardiac surgery warrants thorough investigation for potential complications such as hematoma formation.
• Percutaneous drainage offers a viable, less invasive alternative to surgical intervention for managing localized cardiac hematomas causing hemodynamic compromise.