Rapidly Occurring Left Atrial Chamber Narrowing Percutaneous Coronary Intervention

Masahide Enomoto＊	Takeshi Kinoshita＊	Tomoaki Suzuki＊
Tohru Asai＊

（Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan）

Triple-vessel disease of coronary artery was recognized in the examination of a 78-year-old man when hemodialysis was introduced for diabetic nephropathy. Percutaneous coronary intervention（PCI）was performed as initial treatment for the lesion of the right coronary artery. Contrast CT was performed because of persistent fever from the first day after the PCI. Since the tumor occupying the inside of the left atrium which was not found before PCI we were concerned about the failure of the hemodynamics and decided to treat it surgically. Surgery was performed with off-pump coronary artery bypass grafting, followed by left atrial mass removal surgery under cardiac arrest using cardio-pulmonary bypass. When examining the interior of the left atrium with a right lateral incision of the left atrium, the tumor was found to be on the posterior wall. This surface was smooth, and there was no endometriosis or hematoma. After incising the left atrial adventitia, old hematoma was found in the inside of the left atrium muscle layer, and it was removed as much as possible. The left atrial tumor was actually an intramural hematoma, based on image findings and macroscopic findings. Searching for the cause retrospectively, it was thought that the wire which was displaced during PCI was the cause of bleeding. We confirmed that there was no recurrence of left atrial intramural hematoma on an outpatient visit on the 113th postoperative day. We report a rare case of removing left atrial intramural hematoma under cardiac arrest which appeared after PCI.

 

Jpn. J. Cardiovasc. Surg. 47:118-122（2018）

Keywords：left arterial intramural hematoma;percutaneous coronary intervention;off-pump coronary artery bypass grafting;diabetic kidney disease