Interventricular Septal Hematoma Complicating Left Branch Bundle Lead Implantation

Figures

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  Figure 1. Admission Electrocardiogram

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  Figure 2. Initial Diagnostic Tests (A) Fistula from the first and second septal branches of the left anterior descending artery. (B) Fistula from the septal branch of the posterior descending artery. (C) Interventricular septal hematoma (IVSH) by parasternal long-axis view (arrow). (D) Flow by color Doppler inside of IVSH (arrow). (E) Three-dimensional echocardiogram of IVSH (arrow). (F) Computed tomography angiography shows the IVSH (arrow).

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  Figure 3. Coronary Angioplasty and Results Coronary angiography shows the placement of polytetrafluoroethylene-covered stents in the left anterior descending artery and posterior descending artery to close respective fistulas. (A) Stents (arrow) in the left anterior descending artery. (B) Absence of flow through fistulas. (C) Stent (arrow) in branch of posterior descending artery. (D) Absence of flow through fistula.

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  Figure 4. Follow-up Echocardiogram Echocardiography 7 days after angioplasty shows (A) that the interventricular septal hematoma decreased size (arrow) and (B) no flow by color Doppler (arrow). After 6 months: (C) highlighted absence of interventricular septal hematoma (arrow) and (D) no flow inside of septum (arrow).