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Left Atrial Compression Caused by an Intrapericardial Hematoma after Coronary Artery Bypass Graft Surgery

Jeroen Walpot1, Masoud Sadreddini1

  • 1Department of Cardiology, Admiraal De Ruyter Ziekenhuis, Vlissingen and Goes, The Netherlands.

The Journal of Emergency Medicine
|June 30, 2016
PubMed

Insights

Left atrial compression (LAC), a rare condition mimicking mitral stenosis, can cause severe symptoms. Emergency physicians must recognize LAC caused by pericardial hematoma after coronary artery bypass graft surgery.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Cardiac Surgery

Background:

  • Left atrial compression (LAC) is an uncommon condition causing left ventricular inflow obstruction, mimicking mitral stenosis.
  • Symptoms include hypotension, syncope, shock, and pulmonary congestion due to increased left atrial pressure.

Observation:

  • An 84-year-old man developed LAC due to a pericardial hematoma, a complication of coronary artery bypass graft (CABG) surgery, presenting 3 weeks postoperatively.
  • Initial echocardiography before discharge did not reveal the hematoma or tamponade, with diagnosis occurring 6 days later.

Findings:

  • Postoperative pericardial hematoma can cause focal tamponade leading to left atrial compression, especially with scar formation and adhesions.
  • Literature on LAC is limited, with gastrointestinal structures and thoracic aorta being more commonly reported causes.

Implications:

  • Emergency physicians must consider delayed presentation of intrapericardial tamponade as a cause of LAC following CABG surgery.
  • Bedside echocardiography plays a crucial role in the emergency department diagnosis of LAC.
Abstract

Keywords:
echocardiographyfocal pericardial tamponadeintrapericardial hematomaleft atrial compression

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