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Barbone A, Iaccarino A, Tosi P, Regazzoli Lancini D, Crescenzi G, Reimers B, Torracca L. Intracardiac hematoma treated conservatively by ECMO support. Artif Organs 2022; 46:1436-1438. [PMID: 35502745 DOI: 10.1111/aor.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Clinical pathway of an intracardiac hematoma treated by ECMO support.
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Affiliation(s)
- Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Paolo Tosi
- Cardiovascular Department, UO of Cardiac Anesthesia of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Damiano Regazzoli Lancini
- Cardiovascular Department, UO of Interventional Cardiology of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Crescenzi
- Cardiovascular Department, UO of Cardiac Anesthesia of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Bernhard Reimers
- Cardiovascular Department, UO of Interventional Cardiology of the IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of the IRCCS Humanitas Research Hospital, Rozzano, Italy
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Divanji P, Shunk K. Complications of chronic total occlusion percutaneous coronary intervention: Subepicardial hematoma. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:553-557. [PMID: 29331435 DOI: 10.1016/j.carrev.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
A 67-year-old man with coronary artery disease and previous coronary underwent successful Guideliner reverse CART percutaneous coronary intervention of a chronic total occlusion of the right coronary artery. He later developed evidence of myocardial ischemia, and imaging, including angiogram, echocardiogram, and cardiac computed tomography revealing active dye extravasation from the previously normal RV marginal branches, in addition to a large subepicardial hematoma. Despite these dramatic findings, the patient remained hemodynamically stable and pain-free, with resolving ECG changes. Thus, with close clinical observation, the patient did not undergo pericardiocentesis or other invasive procedures, and was discharged home safely. This review evaluates the complications of CTO-PCI, with a focus on subepicardial hematomas, discussing diagnosis and management of this highly morbid complication.
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Affiliation(s)
- Punag Divanji
- Division of Cardiology, University of California, San Francisco, VA Medical Center, San Francisco, CA, United States.
| | - Kendrick Shunk
- Division of Cardiology, University of California, San Francisco, VA Medical Center, San Francisco, CA, United States
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Grieshaber P, Nef H, Böning A, Niemann B. Myocardial Ischemia Caused by Subepicardial Hematoma. Thorac Cardiovasc Surg Rep 2017; 6:e5-e9. [PMID: 28352501 PMCID: PMC5367147 DOI: 10.1055/s-0037-1601315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Bleeding from bypass anastomosis leakage occurs early after coronary
artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous
bleeding is unlikely. Case Description A 63-year-old male patient developed a pseudoaneurysm-like,
subepicardial late-term bleeding resulting in a hematoma that compromised coronary
artery flow by increasing extracoronary pressure. This resulted in severe angina
pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the
affected area. After surgical removal of the hematoma and repair of the anastomosis, the
patient's symptoms disappeared and no signs of myocardial ischemia were present. Conclusion Surgical removal is an efficient therapy for subepicardial hematoma
inducing myocardial ischemia.
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Affiliation(s)
- Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital of Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
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Distal coronary perforation in patients with prior coronary artery bypass graft surgery: The importance of early treatment. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:412-7. [DOI: 10.1016/j.carrev.2016.05.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
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Ertan C, Ozeke O, Demir AD. Intramyocardial hematoma with epicardial rupture following percutaneous coronary intervention. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:125-128. [PMID: 22238155 DOI: 10.1002/jcu.21876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
Intramyocardial (or subepicardial) hematomas are uncommon conditions that occur mostly after myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass surgery, cardiac surgery, or chest trauma. Coronary perforation is a rare complication of PCI and the subset of patients developing an intramyocardial hematoma, usually considered a catastrophic event, is even rarer. We describe here the case of 63-year-old man in whom an intramyocardial hematoma with epicardial rupture occurred after PCI. The patient was treated conservatively with a successful outcome.
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Affiliation(s)
- Cagatay Ertan
- Department of Cardiology, Acibadem Hospital, Eskisehir, Turkey
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Furui M, Ohashi T, Yoshida T, Oka F, Hirai Y, Sakakura R, Kageyama S, Kojima A. Cardiogenic shock without cardiac tamponade caused by a subepicardial hematoma after percutaneous coronary intervention. Gen Thorac Cardiovasc Surg 2011; 59:114-6. [PMID: 21308438 DOI: 10.1007/s11748-010-0628-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 04/01/2010] [Indexed: 11/28/2022]
Abstract
A 73-year-old man complaining of pain on effort was admitted to a hospital for a percutaneous coronary intervention (PCI) because of severe stenosis of the mid right coronary artery. During PCI, a coronary artery was ruptured, and the patient suddenly went into shock. Percutaneous pericardiocentesis was successfully performed, and cardiac tamponade was relieved. Despite the echocardiographic finding of no cardiac tamponade, the patient remained in the shock state. An emergency operation was performed. There was little pericardial effusion, but a large subepicardial and intramyocardial hematoma was present and was being compressed by the pericardium. Pericardial incision and off-pump coronary artery bypass grafting were performed. The patient was discharged on the 12th postoperative day. Decompression of the subepicardial hematoma by pericardiotomy ameliorated the condition of the patient, who was in cardiogenic shock. We thus report a rare case of subepicardial hematoma resulting in shock during PCI in which cardiac tamponade was not observed.
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Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
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Kadohira T, Kobayashi Y, Niitsuma Y, Imamaki M, Komuro I. Global ST-segment elevation associated with impending cardiac rupture during diagnostic cardiac catheterization. Int Heart J 2009; 50:539-42. [PMID: 19609057 DOI: 10.1536/ihj.50.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac rupture is a life-threatening complication during diagnostic cardiac catheterization, however, it rarely occurs nowadays. The present case report describes cardiac rupture during diagnostic cardiac catheterization using a 4F pigtail catheter and a 0.035" flexible guidewire, and global ST-segment elevation associated with impending cardiac rupture.
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Affiliation(s)
- Tadayuki Kadohira
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Grohmann A, Elgeti T, Eddicks S, Knebel F, Rutsch W, Melzer C, Baumann G, Borges AC. Interventricular septum hematoma during cineventriculography. Cardiovasc Ultrasound 2008; 6:4. [PMID: 18199315 PMCID: PMC2257924 DOI: 10.1186/1476-7120-6-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 01/16/2008] [Indexed: 12/20/2022] Open
Abstract
Background Intraseptal hematoma and subsequent myocardial infarction due to accidental contrast agent deposition complicating diagnostic cineventriculography is a previously undescribed complication of angiography. Case presentation A 61 year old man was admitted at intensive care unit because of unstable angina pectoris 1 hour after coronary angiography. Transthoracic contrast echocardiography showed a non-perfused area in the middle of interventricular septum with an increase of thickening up to 26 mm. Review of cineventriculography revealed contrast enhancement in the interventricular septum after contrast medium injection and a dislocation of the pigtail catheter tip. Follow up by echocardiography and MRI showed, that intramural hematoma has resolved after 6 weeks. After 8 weeks successful stent implantation in LAD was performed and after 6 month the patient had a normal LV-function without ischemic signs or septal thickening demonstrated by stressechocardiography. Conclusion A safe and mobile position of the pigtail catheter during ventriculography in the middle of the LV cavity should be ensured to avoid this potentially life-threatening complication. For assessment and absolute measurement of intramural hematoma contrast-enhanced echocardiography is more feasible than MRI and makes interchangeable results.
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Affiliation(s)
- Andrea Grohmann
- Department of Cardiology and Angiology, Charite Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany.
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Satler LF. Successful nonsurgical treatment of left main stem perforation by sacrifice of the LAD. Catheter Cardiovasc Interv 2007; 69:850-1. [PMID: 17390324 DOI: 10.1002/ccd.20993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lowell F Satler
- Division of Cardiology, Washington Hospital Center, Washington, DC
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Dixit M, Gan M, Pradeep KK, Dubey A, Sabade S, Mahapatra R. Dissecting Sub-Epicardial Haematoma: A Rare Complication with the Use of Octopus™ Suction Mechanical Stabiliser. Heart Lung Circ 2007; 16:118-9. [PMID: 17317313 DOI: 10.1016/j.hlc.2006.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 09/27/2006] [Accepted: 10/01/2006] [Indexed: 11/24/2022]
Abstract
Mechanical heart stabilisers are the most important method of anastomotic field immobilisation in off pump coronary artery bypass (OPCAB) surgery. The new generations of stabilisers are small, versatile and relatively free of complications. We report a patient who developed a dissecting sub-epicardial haematoma following OPCAB using the OCTOPUS 3.0 (Medtronic Inc., Minneapolis, USA) suction stabiliser, which manifested as myocardial ischaemia two hours after surgery. It is a rare but potentially lethal complication that has only once before been reported in literature.
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Affiliation(s)
- Mahadev Dixit
- Department of Cardiothoracic Surgery, JN Medical College and KLES Hospital and MRC, Belgaum, Karnataka, India
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Barbeau GR, Sénéchal M, Voisine P. Delayed abrupt tamponade by isolated left atrial compression following coronary artery perforation during coronary angioplasty. Catheter Cardiovasc Interv 2005; 66:562-5. [PMID: 16273592 DOI: 10.1002/ccd.20472] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac tamponade following coronary artery perforation during percutaneous coronary intervention is a rare but potentially life-threatening complication. When associated with Ellis type III coronary perforations, tamponade develops rapidly during the intervention. In contrast, Ellis type I and II coronary perforations, because of their contained nature, are usually managed conservatively and rarely result in tamponade. We report two unusual cases of delayed but abrupt tamponade caused by localized left atrial compression after contained coronary artery perforation following angioplasty. This complication is an extremely rare event. Etiology, diagnostic modalities, and management are discussed.
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Quan VH, Stone JR, Couper GS, Rogers C. Coronary artery perforation by cutting balloon resulting in dissecting subepicardial hematoma and avulsion of the vasculature. Catheter Cardiovasc Interv 2005; 64:163-8. [PMID: 15678461 DOI: 10.1002/ccd.20249] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of perforation caused by cutting balloon angioplasty of in-stent restenosis in a saphenous vein coronary bypass graft. This was complicated by a subepicardial hematoma leading to avulsion of the penetrating arteries and cardiogenic shock. Despite surgical evacuation and percutaneous left ventricular assist-device support, death ensued.
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Affiliation(s)
- Vu H Quan
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Chow MY, Misfeld M, Ilsley C, Amrani M, George SJ, Troianos CA. Case 2--2001: detection of subepicardial hematoma after percutaneous transluminal coronary angioplasty. J Cardiothorac Vasc Anesth 2001; 15:111-3. [PMID: 11254851 DOI: 10.1053/jcan.2001.20287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Y Chow
- Department of Anesthetics, Harefield Hospital, Middlesex, United Kingdom
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