Cardiovascular Journal of Africa: Vol 28 No 4 (July/August 2017)

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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
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,
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