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(Circulation. 2005;112:e250-e251.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Tamponade From Acute Left Atrium Compression

Martin Crête, MD; Gérald Barbeau, MD; Olivier Bertrand, MD; Mario Sénéchal, MD

From Laval Hospital, Department of Cardiology, Quebec, Canada.

Correspondence to Mario Sénéchal, MD, Laval Hospital, 2725, Chemin Ste-Foy, Ste-Foy, Québec G1V 4G5, Canada. E-mail michedubois{at}hotmail.com

A 75-year-old man was admitted with acute chest pain, normal ECG, and elevated level of troponin. One month before this admission, he underwent an angioplasty with stent implantation in the left anterior descending and left circumflex coronary arteries.

Because of refractory angina, an angiogram was performed that showed an occlusion of the left circumflex artery distal to the stent. This occlusion was the site of a successful angioplasty. During the procedure, the guidewire caused a perforation of a small atrial branch, located in the atrioventricular sulcus (Figures 1A and 1B). At that time, the angiogram showed a limited coronary perforation without any continuous leak (Figure 1C). The patient was asymptomatic, and vital signs were normal. Four hours later, the patient developed severe bradycardia and hypotension, which was partially corrected with volume and atropine. An echocardiog-raphy done at the bedside demonstrated a compressing local effusion posterior to the left atrium (Figure 2A). A tamponade secondary to a localized compression of the left atrium was suspected. The patient remained unstable and was transferred immediately to the operating room. An echocardiography done before surgery showed a marked increase of the localized effusion posterior to the left atrium (Figure 2B). Surgery revealed a large hematoma located in the atrioventricular sulcus with compression of the left atrium. Biological glue and a patch were applied locally to repair the coronary perforation. The patient had a normal postsurgery recovery and left the hospital 7 days later.

View larger version (63K): [in this window] [in a new window]   Figure 1. A, Right anterior oblique-caudal projection of the left coronary artery after initial balloon angioplasty showing a severe residual stenosis in the left circumflex artery and a small atrial branch (black arrowhead). B, After balloon inflation, a guidewire tip is seen in the atrial branch (white arrowhead), and contrast extravasation is seen in the anterior aspect of the left circumflex artery (black arrowhead). C, After guidewire pullback, significant contrast shadow is seen in the posterior aspect of the left circumflex artery (black arrowhead) but without active extravasation.

View larger version (125K): [in this window] [in a new window]   Figure 2. A, Transthoracic echocardiography long-axis view showing left and right ventricles. A large effusion is seen posterior to the left atrium (white arrowhead). B, Twenty-five minutes after the first echocardiography and just before the patient went into surgery, the effusion posterior to the left atrium nearly doubled. The clinical deterioration and the external compression by the localized effusion posterior to the left atrium is consistent with the diagnosis of left side tamponade originating from the perforation of a small marginal artery located in the atrioventricular sulcus (black arrowhead).

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Issue Highlights
Circulation 2005 112: 2077-2078. [Extract] [Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Crête, M. Articles by Sénéchal, M. Search for Related Content PubMed PubMed Citation Articles by Crête, M. Articles by Sénéchal, M. Related Collections Catheter-based coronary interventions: stents Coronary imaging: angiography/ultrasound/Doppler/CC Echocardiography Related Article