A Case of Right Coronary Artery Hematoma Detected by Echocardiography after Percutaneous Coronary Intervention

Abstract

I In nt tr ro od du uc ct ti io on nCoronary artery perforation is a rare complication during or after percutaneous coronary intervention (PCI) and presents variably from hemodynamically stable concealed hemorrhage to potentially life-threatening cardiac tamponade. Here, we report a patient with coronary artery hematoma associated with coronary artery perforation after failed PCI for chronic total occlusion of right coronary artery, detected on transthoracic echocardiography (TTE). C Ca as se eA 69-year-old man was admitted to our institute with recently aggravated chest pain. He had history of diabetes mellitus. He felt exertional chest pain 6 years ago and was evaluated with coronary angiography which revealed chronic total occlusion of right coronary artery. Medical treatment was initiated and his symptom disappeared thereafter. But, recently he began to have recurrent episodes of exertional chest pain. Exercise stress test was performed and ST segment depression was noted in leads II, III, aVF and V3-6 with typical chest pain. In coronary angiogram, there was 90% stenosis of proximal left anterior descending artery and PCI with stenting was performed.On physical examination, there were no significant findings. Laboratory studies showed no significant abnormalities. The electrocardiogram revealed signs of left atrial enlargement and first degree atrioventricular block with sinus bradycardia. The thoracic roentgenogram showed borderline cardiomegaly. In coronary angiogram, proximal part of the right coronary artery was totally occluded and had collateral flow from left anterior descending artery and left circumflex branch. To perform PCI to stenotic lesion of proximal right coronary artery, we inserted guidewire to proximal right coronary artery but guidewire did not pass through proximal right coronary artery. So we inserted the guidewire to distal right coronary artery using retrograde approach via septal branch of left anterior descending artery. Balloon dilatation underwent using 2.0 mm 15 mm balloon but PCI was failed because the balloon could not pass through the lesion in the mid right coronary artery.Final coronary angiogram showed no extravasation of contrast (Fig. 1). TTE was performed after PCI. The size, shape and function of left ventricle were normal. However, at the right atrioventricular groove, 3.4 cm 2.6 cm-sized prominent epicardial tissue with high echogenecity was noted. The echogenecity of the lesion was higher than that of the pericardial fat, so we interpreted this lesion as a localized A 69-year-old man was admitted to undergo percutaneous coronary intervention (PCI) for chronic total occlusion of right coronary artery. He had diabetes mellitus, stable angina pectoris. Diagnostic coronary angiography demonstrated proximal total occlusion of right coronary artery. PCI was failed due to failure of balloon passage. Echocardiography was performed after PCI and thickened epicardial tissue at right atrioventricular groove was noted. It was highly echogenic and localized along the course of m...