Tamponade From Acute Left Atrium Compression
A 75-year-old man was admitted with acute chest pain, normal ECG, and elevated level of troponin. One month before this admission, he underwent an angioplasty with stent implantation in the left anterior descending and left circumflex coronary arteries.
Because of refractory angina, an angiogram was performed that showed an occlusion of the left circumflex artery distal to the stent. This occlusion was the site of a successful angioplasty. During the procedure, the guidewire caused a perforation of a small atrial branch, located in the atrioventricular sulcus (Figures 1A and 1B). At that time, the angiogram showed a limited coronary perforation without any continuous leak (Figure 1C). The patient was asymptomatic, and vital signs were normal. Four hours later, the patient developed severe bradycardia and hypotension, which was partially corrected with volume and atropine. An echocardiog-raphy done at the bedside demonstrated a compressing local effusion posterior to the left atrium (Figure 2A). A tamponade secondary to a localized compression of the left atrium was suspected. The patient remained unstable and was transferred immediately to the operating room. An echocardiography done before surgery showed a marked increase of the localized effusion posterior to the left atrium (Figure 2B). Surgery revealed a large hematoma located in the atrioventricular sulcus with compression of the left atrium. Biological glue and a patch were applied locally to repair the coronary perforation. The patient had a normal postsurgery recovery and left the hospital 7 days later.