Key result
A 67-year-old man developed a fatal dissecting sub-epicardial hematoma following PCI for in-stent restenosis, highlighting a rare complication of aggressive percutaneous intervention.
Case Report (n=1)
Highlights a rare and fatal complication of aggressive percutaneous intervention (dissecting sub-epicardial hematoma) and the challenges in its surgical management.
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Rare fatal hematoma after aggressive PCI warrants procedural caution; single case leaves open incidence and optimal management.
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.
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Shekar et al. (2004) conducted a case report in Dissecting sub-epicardial hematoma following PCI (n=1). Emergent surgery and percutaneous ventricular assist device was evaluated on Clinical outcome. A 67-year-old man developed a fatal dissecting sub-epicardial hematoma following PCI for in-stent restenosis, highlighting a rare complication of aggressive percutaneous intervention.
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