Dissecting sub-epicardial hematoma--challenges to surgical management

Eur J Cardiothorac Surg. 2004 Oct;26(4):850-3. doi: 10.1016/j.ejcts.2004.06.022.

Abstract

A 67-year-old man developed a large dissecting sub-epicardial hematoma of his heart following a percutaneous coronary interventional procedure. While undergoing a dilatation of in-stent restenosis of a saphenous vein graft to the diagonal artery, he developed an anastomotic perforation that lead to a large sub-epicardial hematoma that sheared of all the epicardial vessels from the underlying myocardium. Emergent surgery was performed as he began to evolve a large myocardial infarction. Evacuation of the hematoma and gluing back of the epicardium was the only operation possible due to the complexity of the problem. Deteriorating hemodynamics post-operatively led to the placement of a percutaneous ventricular assist device despite which he succumbed. This case report is intended to alert the surgical community to such a rare complication of aggressive percutaneous intervention, difficulty in establishing an accurate diagnosis and repairing the sub-epicardial dissecting hematoma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Cardiac Catheterization
  • Coronary Artery Bypass
  • Fatal Outcome
  • Graft Occlusion, Vascular / therapy
  • Heart Diseases / etiology
  • Heart Diseases / pathology
  • Heart Diseases / surgery*
  • Hematoma / etiology
  • Hematoma / pathology
  • Hematoma / surgery*
  • Humans
  • Male