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Eur J Cardiothorac Surg 2004;26:850-853
© 2004 Elsevier Science NL

Case report

Dissecting sub-epicardial hematoma—challenges to surgical management

^a Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
^b Division of Pathology, Brigham and Women's Hospital, Boston, MA, USA

Received 7 May 2004; received in revised form 7 June 2004; accepted 8 June 2004.

^* Corresponding author. Tel.: +1-617-732-7678; fax: +1-617-732-6559. (E-mail: gcouper{at}partners.org).

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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