A case report of right ventricular compression from a septal haematoma during retrograde coronary intervention to a chronic total occlusion

Darshan Doshi; Raja Hatem; Amirali Masoumi; Dimitri Karmapaliotis

doi:10.1093/ehjcr/ytz089

A case report of right ventricular compression from a septal haematoma during retrograde coronary intervention to a chronic total occlusion

Eur Heart J Case Rep. 2019 Sep 1;3(3):ytz089. doi: 10.1093/ehjcr/ytz089.

Authors

Darshan Doshi¹, Raja Hatem², Amirali Masoumi¹, Dimitri Karmapaliotis¹

Affiliations

¹ Department of Medicine, Division of Cardiology, Columbia University Medical Center, 161 Ft. Washington Avenue, Herbert Irving Pavilion, 6th Floor, New York, NY, USA.
² Department of Medicine, Division of Cardiology, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.

Abstract

Background: Septal haematomas causing left ventricular or biventricular outflow obstruction are rare but known complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can be life-threatening.

Case summary: In this case, we describe the formation of a septal haematoma during retrograde CTO PCI. The patient was initially managed conservatively but became progressively unstable, for which she underwent coiling of the inflow and outflow of the septal perforator. Despite coiling, she developed near complete right ventricular outflow obstruction (based on echocardiography). She was successfully managed with a percutaneous right ventricle assist device, with subsequent resolution of the outflow obstruction.

Discussion: Septal haematomas with resultant outflow obstruction have been uniformly fatal. In our case, the use of a percutaneous right ventricle assist device was life-saving.

Keywords: Case report; Chronic total occlusion; Outflow obstruction; Percutaneous coronary intervention; Septal haematoma.