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(Circulation. 2007;115:e603-e606.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Conservative Treatment of a Left Atrial Hematoma and a Localized Tamponade Occurring During Treatment of Coronary Total Occlusion

Davide Tavano, MD; Mauro Carlino, MD; Matteo Pisani, MD; Antonio Colombo, MD

From the San Raffaele Scientific Institute, Milan, Italy.

Correspondence to Antonio Colombo, MD, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. E-mail colombo@emocolumbus.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Cardiac tamponade during percutaneous coronary intervention is a rare but serious complication that can occur after coronary perforation. Even more infrequent is a tamponade subsequent to a localized left atrial hematoma. In the literature, we found just 5 similar cases, and all of them underwent surgical intervention.^1–4 The surgical option, using a median sternotomy or left thoracotomy approach, was taken in the first hours after the procedure because of progressive hemodynamic deterioration. In 4 of them, it consisted of hematoma drainage and atrial decompression; in 1 patient, the surgical option was vessel wall repair. We report our experience of a patient who sustained this complication as a consequence of a large right coronary dissection. The patient was treated conservatively with a successful outcome.

A 65-year-old man, previously treated with coronary artery bypass graft surgery and coronary percutaneous revascularization, was still symptomatic with effort angina refractory to maximal medical treatment. Myocardial scintigraphy showed evidence of inducible ischemia in the inferolateral left ventricular wall. He was hospitalized in our institution to attempt to recanalize the chronic occlusion of the right coronary artery (RCA). During the procedure, a subintimal dissection occurred in the middistal segment of the right coronary artery (Figure 1A and 1B), and in the more distal part of the posterolateral vessel, it resulted in a perforation of an atrial branch. Perivascular dye staining and contained extravasation were observed, although no pericardial opacification was noticed at fluoroscopy. After a few minutes, hemodynamic instability occurred, requiring dopamine support. The transthoracic . . . [Full Text of this Article]

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Circulation 2007 115: 2789. [Extract] [Full Text]