title: Cardiogenic shock without cardiac tamponade caused by a subepicardial hematoma after percutaneous coronary intervention.
abstract: A 73-year-old man complaining of pain on effort was admitted to a hospital for a percutaneous coronary intervention (PCI) because of severe stenosis of the mid right coronary artery. During PCI, a coronary artery was ruptured, and the patient suddenly went into shock. Percutaneous pericardiocentesis was successfully performed, and cardiac tamponade was relieved. Despite the echocardiographic finding of no cardiac tamponade, the patient remained in the shock state. An emergency operation was performed. There was little pericardial effusion, but a large subepicardial and intramyocardial hematoma was present and was being compressed by the pericardium. Pericardial incision and off-pump coronary artery bypass grafting were performed. The patient was discharged on the 12th postoperative day. Decompression of the subepicardial hematoma by pericardiotomy ameliorated the condition of the patient, who was in cardiogenic shock. We thus report a rare case of subepicardial hematoma resulting in shock during PCI in which cardiac tamponade was not observed.
authors.affiliation: Cardiovascular Surgery Department, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Furui
authors.forename: Takeki
authors.initials: T
authors.lastname: Ohashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Fujihiro
authors.initials: F
authors.lastname: Oka
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Hirai
authors.forename: Reo
authors.initials: R
authors.lastname: Sakakura
authors.forename: Souichirou
authors.initials: S
authors.lastname: Kageyama
authors.forename: Akinori
authors.initials: A
authors.lastname: Kojima
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump; D023921:Coronary Stenosis / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries* / Q000601:surgery; D019299:Decompression, Surgical; D006335:Heart Injuries / Q000209:etiology* / Q000601:surgery; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D020519:Pericardiocentesis; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome