Interventricular Septal Hematoma after Retrograde Intervention for a Chronic Total Occlusion of a Right Coronary Artery: Echocardiographic and Magnetic Resonance Imaging-Diagnosis and Follow-Up

Case Reports in Medicine
Makoto ArakiTsunekazu Kakuta

Abstract

The reverse CART technique provides the potential to modify the retrograde procedure by improving the controlled movement of the retrograde wire and improve the success rates of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Development of interventricular hematoma is a rare complication of CTO PCI. A 63-year-old man with effort angina with a right coronary artery CTO lesion underwent PCI by retrograde approach from the LAD to a septal branch. A contrast "stain" was demonstrated surrounding the septal collateral channel used for the retrograde approach at the end of the procedure without symptom. Echocardiography indicated an increased interventricular septum thickness with low echo signals region and decreased contractility. Cardiac magnetic resonance (CMR) imaging using gadolinium showed a diffusely thickened septum with a low signal fusiform neocavitation delimited by an enhanced-signal ring suggesting intraventricular septal dissecting hematoma. After conservative treatment, follow-up echocardiogram and CMR showed the resolution of the hematoma without clinical events. This case highlights the potentially lethal complication of septal perforator dissection and hematoma that may cause severe myoca...Continue Reading

References

Jun 23, 2006·International Journal of Cardiology·Tsung-Hsien LinSheng-Hsiung Sheu
Jul 15, 2006·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·Massimo A PadalinoGiovanni Stellin
Jan 18, 2008·Cardiovascular Ultrasound·Andrea GrohmannAdrian C Borges
Jun 3, 2008·European Heart Journal·Jian ZhuangXinsheng Huang
Jan 29, 2010·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Arnaud LazarusGaël Jauvert

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