Author + information
- Received March 14, 2017
- Revision received April 27, 2017
- Accepted May 4, 2017
- Published online August 7, 2017.
- Rebeca Lorca, MDa,∗ (, )
- Isaac Pascual, MD, PhDa,
- Alfonso Suarez-Cuervo, MDa,
- María Martín, MD, PhDa,
- Juan Calvo, MD, PhDb,
- Cecilia Corros, MDa,
- Helena Cigarrán, MDb,
- Pablo Avanzas, MD, PhDa,
- Daniel Hernández-Vaquero, MD, PhDc and
- César Morís, MD, PhDa
- aDepartment of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- bDepartment of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- cDepartment of Cardiovascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
- ↵∗Address for correspondence:
Dr. Rebeca Lorca, Hospital Universitario Central de Asturias, Department of Cardiology, Avd/Roma sn, 33011 Oviedo, Spain.
Interventricular septal hematoma is a rare but potentially dangerous complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) (1,2).
A 58-year-old man was referred for right coronary artery CTO-PCI performed by a retrograde approach via the collateral septal artery (Figures 1A and 1B). The procedure was successful, although a little contrast “stain” was visualized surrounding the collateral septal (Figure 1C, Online Video 1). Two hours after, he developed chest pain, ST-segment elevation, hypotension, and tachycardia. Emergency coronary angiography ruled out both stent occlusion and progression of the contrast “stain.”
An impressive interventricular septal hematoma (5 × 3.9 cm) was found on echocardiogram (Figure 1D, Online Video 2), with a mass effect producing left ventricular outflow tract (LVOT) obstruction. This could explain both the symptoms and hemodynamic situation. In order to complete the study, later on, computed tomography angiography and cardiac magnetic resonance imaging (Figures 1E to 1H) were performed.
Three days after monitoring and strictly controlled medical treatment in the coronary unit, the clinical situation improved, the hematoma diminished, and LVOT obstruction disappeared.
This severe intramyocardial hematoma due to a retrograde CTO-PCI complication, with functional repercussions, was successfully managed with a conservative approach.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 14, 2017.
- Revision received April 27, 2017.
- Accepted May 4, 2017.
- 2017 American College of Cardiology Foundation