Background Image
Table of Contents Table of Contents
Previous Page  83 / 88 Next Page
Information
Show Menu
Previous Page 83 / 88 Next Page
Page Background

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017

AFRICA

e9

Case Report

Left ventricular haematoma mimicking lateral wall

myocardial infarction secondary to percutaneous

coronary intervention

Omer Senarslan, Necdet Batuhan Tamci, Umut Hasan Kantarci, Mehmet Eyuboglu, Dilsad

Amanvermez Senarslan

Abstract

Dissecting intra-myocardial haematoma is a rare disease

and a potentially fatal complication after cardiac surgery.

Patients with previous heart surgery have more risk for

dissecting intra-myocardial haematoma after percutaneous

coronary intervention. Management of this issue is challeng-

ing. We describe a rare case of a 63-year-old woman with a

left ventricular wall-dissecting intra-myocardial haematoma,

which developed 30 minutes after percutaneous coronary

intervention. The patient was treated conservatively, with a

successful outcome.

Keywords:

percutaneous coronary intervention, complication,

dissecting intra-myocardial haematoma

Submitted 10/4/16, accepted 16/10/16

Published online 10/11/16

Cardiovasc J Afr

2016;

27

: e9–e11

www.cvja.co.za

DOI: 10.5830/CVJA-2016-090

Intra-myocardial haematoma is a rare disease and is usually

associated with multiple pathologies such as myocardial

infarction, chest trauma, coronary artery bypass surgery and

complications of percutaneous coronary intervention (PCI),

or it could occur spontaneously.

1

Dissecting intra-myocardial

haematoma (DIH) is a potentially fatal complication that is

characterised anatomically and pathologically into different

forms. Sub-epicardial or intra-myocardial haematoma occurs

rarely and has been reported mainly in patients with previous

coronary artery bypass graft (CABG) who undergo PCI.

Case report

A 63-year-old woman was admitted to our clinic with complaints

of chest pain on effort. There was a record of CABG carried out

in 2011. Coronary angiography revealed severe stenosis (99%) in

the middle part of the circumflex artery (Cx) (Fig. 1A). PCI was

chosen as the treatment option for the Cx lesion.

We crossed the lesion with a 0.014-inch hydrophilic guide-

wire PT2-LS (Boston Scientific, Natick, MA) and it was

advanced distally into the Cx. We performed pre-dilatation with

a coronary balloon under nominal pressure, and a 2.75

×

23-mm

Xience stent (Abbott Laboratories, Abbott Park, IL, USA)

was implanted under nominal pressure. The final angiogram

revealed acceptable results in the Cx with no abnormal findings

or contrast dye leakage.

The patient was taken to the cardiology department after PCI.

Thirty minutes after the procedure, she suddenly complained of

severe chest pain and discomfort. An ECG showed ST elevations

in D1 and aVL deviations (Fig. 1B).

We assumed acute stent thrombosis, so we took the patient

back to the catheterisation laboratory. We saw no thrombus

in the stent but noticed deterioration of blood flow in the

intermediate artery (Fig. 1C).

We checked the patient with echocardiography to see if

there was a problem with the pericardium or myocardium.

Two-dimensional echocardiography revealed a large 5.1

×

1.4-cm

echolucent area without fluid in the pericardium (Fig. 2A). We

presumed this echolucent area was a dissecting intra-myocardial

haematoma in the lateral wall of the myocardium, which was

compressing the intermediate artery.

Repeated bedside echocardiography revealed no change in the

size of the haematoma and no deterioration in left ventricular

ejection fraction or valve function on the first two days of clinical

follow up. Although the left ventricular lateral wall haematoma

was large enough to cause complications, it was stable, so we

decided to follow the patient conservatively with standard

Department of Cardiology, Medifema Hospital, Izmir, Turkey

Omer Senarslan, MD,

dromersen@yahoo.com

Department of Cardiology, Izmir Atasaglik Hospital, Izmir,

Turkey

Necdet Batuhan Tamci, MD

Department of Radiology, Izmir Esrefpasa Hospital, Izmir,

Turkey

Umut Hasan Kantarci, MD

Department of Cardiology, Special Izmir Avrupa Medicine

Center, Karabaglar, Izmir, Turkey

Mehmet Eyuboglu, MD

Department of Cardiovascular Surgery, School of

Medicine, Celal Bayar University, Manisa, Turkey

Dilsad Amanvermez Senarslan, MD