Acute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft
Michael Johnson1, Arun Kumar2, Bradford L Cardonell3
1University of Missouri School of Medicine, Columbia, MO.
Insights
A rare intramyocardial hematoma (IH) caused right ventricular failure and cardiogenic shock after coronary artery bypass graft (CABG) surgery. This complication, previously unreported after CABG, requires high suspicion for diagnosis and individualized treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for multivessel coronary artery disease.
- Hemodynamic instability post-CABG can necessitate mechanical circulatory support.
- Right ventricular failure is a serious complication following cardiac surgery.
Observation:
- A 50-year-old woman developed unexplained hemodynamic instability after CABG.
- Mechanical support was required to wean the patient from cardiopulmonary bypass.
- Postoperative coronary angiography revealed a right ventricular intramyocardial hematoma (IH).
Findings:
- The intramyocardial hematoma (IH) was identified as the primary cause of right ventricular failure and cardiogenic shock.
- This specific complication (IH) following CABG has not been previously documented in medical literature.
- Intramyocardial hematoma requires a high index of suspicion for diagnosis, often aided by transesophageal echocardiography.
Implications:
- Intramyocardial hematoma is a rare but critical postoperative complication after CABG.
- Early suspicion and diagnosis of IH are crucial for managing unexplained hemodynamic instability.
- Current treatment strategies for IH are not standardized and are tailored to individual patient conditions and hemodynamic status.
Abstract:
A 50-year-old woman underwent coronary artery bypass graft (CABG) for multivessel coronary artery disease. Due to hemodynamic instability, the patient could not be weaned from cardiopulmonary bypass without mechanical support, even after multiple attempts. Subsequently, a right ventricular intramyocardial hematoma (IH) was found during postoperative coronary angiography. The IH was felt to be the main contributing factor leading to right ventricular failure and cardiogenic shock, which, to the authors' knowledge, has not been previously reported after CABG. An IH is a rare complication postoperatively that often requires a high level of suspicion to identify on transesophageal echocardiogram. It should be suspected when there is hemodynamic instability intraoperatively or postoperatively in the intensive care unit that cannot be explained easily. There currently is no standard treatment. Treatment often is based on the individual patient and degree of hemodynamic instability.
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