Key result
Staged VA-ECMO, coil embolization, and surgical evacuation successfully resolve LA intramural hematoma.
Why the study?
Left atrial intramural hematoma is a rare complication related to cardiac interventions such as PCI, presenting challenging management.
Case Report (n=1)
No
Staged management with ECMO support can provide a crucial temporal window for diagnosis and facilitate recovery in critically ill patients with left atrial intramural hematoma and cardiogenic shock following PCI.
May support ECMO-bridged staged care in post-PCI left atrial intramural hematoma with shock; hypothesis-generating and requires prospective validation.
Left atrial intramural hematoma (LAIH) is a rare complication related to various cardiac interventions, including cardiac surgery, catheter-based arrhythmia ablation, and percutaneous coronary intervention (PCI), all of which may involve manipulation of the left atrium (LA). Here, we describe the challenging management of a patient who developed LAIH after PCI. A 72-year-old male patient was transferred to our hospital for the management of LAIH after PCI. Owing to cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. Repeat coronary angiography confirmed perforation of the left circumflex coronary artery; thus, coil embolization was performed. Subsequently, emergency surgical evacuation of the LA hematoma was performed to relieve the hemodynamic instability and impaired intracavitary flow. ECMO was weaned the day after surgery, and the patient made a full recovery. Even in critically ill patients, staged management with ECMO support should be considered to facilitate recovery.
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Lee et al. (2026) conducted a case report in Left atrial intramural hematoma (n=1). Staged management with veno-arterial extracorporeal membrane oxygenation (ECMO), coil embolization, and surgical hematoma evacuation was evaluated. Staged management with veno-arterial extracorporeal membrane oxygenation support, coil embolization, and surgical evacuation successfully treated a patient with left atrial intramural hematoma.
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