Related Experiment Video
Updated: Sep 8, 2025
06:10
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
3.4K
Coronary Artery Perforation Resulting in a Loculated Extracardiac Hematoma: The Pressures to Intervene
David O'Sullivan1, Robert O'Dowling2, Crochan J O'Sullivan3
1Mater Misericordiae University Hospital, Dublin, Ireland.
JACC. Case Reports
|June 13, 2022
Insights
A large hematoma developed after a complex heart procedure. Prompt liquefaction treatment successfully resolved the complication in this cardiac patient.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Complications
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) is a complex procedure.
- Retrograde CTO-PCI techniques carry specific risks, including vascular complications.
- Patients with extensive cardiac histories may have increased susceptibility to procedural complications.
Observation:
- An 86-year-old male patient with a history of coronary artery bypass grafting (CABG) developed a significant (350 mL) delayed extracardiac hematoma.
- The hematoma occurred following a retrograde chronic total occlusion-percutaneous coronary intervention (CTO-PCI).
Findings:
- The extracardiac hematoma was successfully treated.
- Liquefaction of the hematoma was the successful therapeutic outcome.
Implications:
- This case highlights the potential for delayed extracardiac hematomas after complex CTO-PCI.
- Successful liquefaction therapy offers a treatment option for managing such hematomas.
- Awareness of this complication is crucial for interventional cardiologists performing advanced PCI procedures.
Abstract:
We describe the case of an 86-year-old man with an extensive cardiac history, including previous coronary artery bypass grafting, who experienced a delayed extracardiac hematoma, 350 mL in volume, after retrograde chronic total occlusion-percutaneous coronary intervention. The patient was successfully treated with resultant liquefaction of the hematoma. (Level of Difficulty: Advanced.).
Keywords:
CABG, coronary artery bypass graftCAD, coronary artery diseaseCAP, coronary artery perforationCTO, chronic total occlusionLCx, left circumflex arteryLMS, left main stemOM1, obtuse marginal arteryPCI, percutaneous coronary interventionSVG, saphenous vein graftcardiac magnetic resonancecomplicationcomputed tomographyechocardiographypercutaneous coronary intervention
Related Concept Videos
01:22Esophageal Perforation-I: Introduction
166
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
166
01:28Esophageal Perforation-II: Clinical Manifestations and Management
145
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
145
01:20Extrinsic and Intrinsic Pathways of Hemostasis
9.1K
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
9.1K
01:26Aneurysm III: Interprofessional Care
24
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
24
01:21Coronary Circulation
3.9K
The heart, an organ critical to survival, gets nourishment not from the blood it pumps but from a separate circulation system known as coronary circulation. This is the shortest circulation in the body and is responsible for supplying the heart with the nutrients it needs to function effectively.
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
3.9K
01:05Introduction to Hemostasis
8.9K
Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
8.9K