Cardiogenic Shock Caused by a Large Sub-Epicardial Hematoma Complicating Percutaneous Coronary Intervention

Abstract

A 56-year-old man with a history of old myocardial infarction and coronary artery bypass grafting was performed percutaneous coronary intervention to the totally occluded lesion of native left anterior descending artery. He developed a coronary arterial perforation that led to a large dissecting sub-epicardial hematoma. Emergent surgery was performed, and a large hematoma was removed from the sub-epicardial space. Continuous drainage of blood was observed after surgery, and the patient died due to the development of multiorgan dysfunction. An autopsy revealed an extensive sub-epicardial hematoma on the lateral wall of the left ventricle and broad necrosis of the myocardium in the lateral wall.

Coronary Artery Perforation, Subepicardial Hematoma, and Cardiac Tamponade After Complex Percutaneous Coronary Intervention

“…Coronary perforation and tamponade are uncommon complications of PCI (during CTO and PCI: 2.9% and 0.3%, respectively), and subsequent cardiac hematoma is even more rare ( 1 ). Cardiac hematomas are considered incomplete cardiac ruptures with a high fatality rate, mainly occurring after myocardial infarction, chest traumas, cardiac surgery, or PCI procedures ( 2 , 3 , 4 , 5 ).…”

“…Urgently performed TTE missed the SEH, and the importance of TEE was unquestionable, yet performing it in an awake patient could add to the already existing respiratory distress. The hemodynamic status was compromised by hypovolemia and loss of cardiac output due to damaged muscle and tamponade ( 3 , 4 , 5 ). Mechanical support could be helpful to stabilize hemodynamics at the expense of additional anticoagulation regimens that are harmful in a patient with hemorrhagic complications ( 2 , 5 ).…”