Author + information
- Received March 24, 2015
- Revision received April 23, 2015
- Accepted May 7, 2015
- Published online October 1, 2015.
- M. Fuad Jan, MBBS, MD,
- Suhail Allaqaband, MD,
- Khawaja Afzal Ammar, MD,
- Sara Fetke, APNP and
- A. Jamil Tajik, MD∗ ()
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Milwaukee, Wisconsin
- ↵∗Reprint requests and correspondence:
Dr. A. Jamil Tajik, Aurora Cardiovascular Services, St. Luke’s Medical Center, 2801 West Kinnickinnic River Parkway, #840, Milwaukee, Wisconsin 53215.
Successful percutaneous coronary intervention (PCI) was performed on a 75-year-old woman for an inferior ST-segment elevation myocardial infarction (STEMI) (Figures 1A and 1B, Online Videos 1 and 2). Persistent staining of contrast material (Figure 1C, Online Videos 3 and 4) post-PCI prompted emergent transthoracic echocardiography (TTE) in the catheterization laboratory to rule out pericardial effusion. TTE revealed a small intramural base-to-mid-right ventricular free wall hematoma (RVFWH). The latter progressively increased in size (maximal size, 4 × 2.4 cm) over the next few days to become bilobed, but with no communication with the RV cavity (Figures 1D to 1G, Online Videos 5, 6, 7, 8, 9). Multimodality imaging with computed tomography (Figure 1H) and magnetic resonance imaging (Figure 1I, Online Video 10) confirmed the diagnosis of RVFWH. Repeat TTE 2 months later showed nearly complete resolution of the RVFWH (Figure 1J, Online Video 11) with excellent recovery of peak systolic strain of the right ventricle (from −5% to −25%) (Figures 1K and 1L, Online Video 5).
Post-infarction intramyocardial hemorrhage/hematoma (involving either the right or left ventricle) after PCI for STEMI is a singular event. The incidence and natural history after PCI in the contemporary era are unknown. Reperfusion post-PCI in the distressed endothelium is likely followed by a complex cascade of events culminating in increased matrix metalloproteinase concentrations, providing a ripe bed for the development of intramyocardial hemorrhage. No comparative studies exist on the best imaging modality to optimize identification of a post-infarction intramyocardial hematoma. Multimodality cardiac imaging as delineated can be useful for both diagnosis and risk stratification.
- Received March 24, 2015.
- Revision received April 23, 2015.
- Accepted May 7, 2015.
- 2015 American College of Cardiology Foundation