PMC4826910_01
Coronary angiography after admission revealed long 90% diameter stenosis within the prestented right coronary artery (RCA), which was determined as the culprit lesion.
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Coronary angiography over the right radial approach revealed a severe 3-vessel coronary artery disease with diffuse moderate stenosis of left anterior-descendens (LAD), ramus circumflexus (LCX), and long 90% diameter stenosis within the prestented right coronary artery (RCA), which was determined as the culprit lesion (Figure 1).
Coronary angiography after predilation and implantation of four drug eluting stents in the right coronary artery showed acceptable result.
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The angiographic result was acceptable (Figure 2) and the patient free of complaints.
ECG after the index PCI revealed increased transient ST-elevation in the anteroseptal leads V2-V5.
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Because of increased transient ST-elevation in the anteroseptal leads V2-V5 (Figure 3) and recurrent angina pectoris second-look angiography was performed one hour after the index procedure, which confirmed the final result of index procedure in the RCA and spasm of the medial LAD with resolution after intracoronary administration of 0.2 mug nitroglycerin with accompanying ST-resolution and chest pain regression. 24 hours later patient complained of chest pain again.
Echocardiogram shows a huge swelling of the intraventricular septal wall with compression of the right ventricle.
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Emergency echocardiography (Figure 4) showed a huge swelling of the intraventricular septal wall with compression of the right ventricle and congestion in the hepatic veins, but no pericardial effusion.
CT scan confirms a huge intraventricular septum-hematoma.
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Computer tomography (CT) and cardiac magnetic resonance (CMR), for better evaluation of myocardial tissue with regard to vitality, confirmed solid (4.9 x 9.2 cm end-diastolic; Figures 5 and 6(a)) intraventricular septum-hematoma with obliteration of the right ventricular cavity.
Follow-up CMR after one month (b) and 6 months (c) revealed a nearly complete resolution of the hematoma, top row: end-diastolic phase of a 4D cine-SSFP sequence of a basal slice in a short axis view, bottom row: corresponding late gadolinium enhancement images. LGE imaging revealed a transmural LGE with a central intramural hypointensity, corresponding to an intramural haematoma extending from the septal to the inferior wall, from the base to the apex.
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Computer tomography (CT) and cardiac magnetic resonance (CMR), for better evaluation of myocardial tissue with regard to vitality, confirmed solid (4.9 x 9.2 cm end-diastolic; Figures 5 and 6(a)) intraventricular septum-hematoma with obliteration of the right ventricular cavity. Fortunately, follow-up echocardiography as well as CMR after one month, Figure 6(b), and two months and six months, Figure 6(c), presented a nearly complete resolution of the hematoma and decreasing obliteration of the right ventricular cavity.