Case report: Recovery after large intramyocardial dissecting haematoma of the ventricular septum—a rare complication of myocardial infarction

Abstract Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echocardiography and confirmed by both computed tomography (CT) and magnetic resonance imaging (MRI). With non-surgical treatment, the patient remained clinically stable. Repeated echocardiography showed gradual regression of the haematoma. Follow-up echocardiography 3 months after the initial diagnosis demonstrated no evidence of septal haematoma. Discussion This report suggests that even large intramyocardial haematoma may recede without operative intervention. Echocardiography, CT, and MRI are all helpful in quantifying the size of the haematoma. The appropriate management should be patient-oriented, depending on clinical stability and progression of the haematoma. Conservative treatment in clinically stable patients suffering from septal haematoma following MI and coronary intervention can be a feasible option.

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Giant Intrahepatic Subcapsular Haematoma: A Rare Complication following Laparoscopic Cholecystectomy—A Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2020/6410790 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Eltaib Saad ◽

Lauren O’Connell ◽

Anne M. Browne ◽

W. Khan ◽

R. Waldron ◽

...

Keyword(s):

Rare Complication ◽

Rare Event ◽

Decisive Role ◽

Postoperative Monitoring ◽

Refractory Hypotension ◽

Life Threatening ◽

The Right ◽

Tomography Scan

We report on a 59-year-old female with symptomatic cholelithiasis on a background of morbid obesity who underwent an elective LC with an uncomplicated intraoperative course; however, she experienced a refractory hypotension within one hour postoperatively with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. A triphasic computed tomography scan revealed a large intrahepatic subcapsular haematoma (ISH) measuring 21 cm × 3.1 cm × 17 cm surrounding the lateral surface of the right hepatic lobe without active bleeding. She was managed conservatively with serial monitoring of haemoglobin and haematoma size. A follow-up ultrasound scan after eight weeks confirmed complete resolution of the haematoma. Giant ISH is a fairly rare, but life-threatening complication following LC which merits special attention. This case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH, although being rare event, in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH.

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Appearance of cerebellar cyst following microvascular decompression to treat hemifacial spasm: a report of two cases and literature review

Journal of International Medical Research ◽

10.1177/0300060520932118 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052093211

Author(s):

Yu Cui ◽

Zhong-Xi Yang ◽

Chun-Mei Wang ◽

Zhan-Peng Zhu

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Rare Complication ◽

Intracerebral Haematoma ◽

Appropriate Treatment ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Safe Approach

Microvascular decompression (MVD) is an effective and safe approach for treating hemifacial spasm (HFS). Postoperative complications may include facial nerve palsy, hearing loss, intracerebral haematoma, and brainstem infarction. The occurrence of intracranial cyst following MVD is extremely rare, with few cases documented in the literature. Herein, the cases of two patients with HFS who developed ipsilateral cerebellar cyst following MVD are reported. The first patient was a 50-year-old male presenting with a 6-year history of HFS on the right side of his face. MVD was performed, and 12 days postoperatively he developed dizziness and nausea. Magnetic resonance imaging (MRI) showed a cyst in the ipsilateral cerebellum. Antibiotic treatment provided no benefit, and the cyst was drained. The second patient was a 44-year-old female presenting with a 4-year history of HFS on the right side of her face. MVD was performed, and 18 days following surgery, she developed dizziness and nausea. MRI showed an ipsilateral cerebellar cyst. Conservative treatment was applied and the cyst shrunk. At the 2-month follow-up appointment, symptoms were completely resolved in both patients. Cerebellar cyst is a rare complication following MVD. Timely diagnosis and appropriate treatment should be emphasized, and surgical treatment may be unnecessary.

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What is the cause of hypotension? A rare complication of percutaneous coronary intervention of a chronic total occlusion: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz184 ◽

2019 ◽

Author(s):

Vincenzo Vetrugno ◽

Harish Sharma ◽

Jonathan N Townend ◽

Sohail Q Khan

Keyword(s):

Coronary Arteries ◽

Rare Complication ◽

Coronary Intervention ◽

Percutaneous Treatment ◽

Total Occlusion ◽

Severe Hypotension ◽

Atrioventricular Groove ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

High Index Of Suspicion

Abstract Background In the last few years, complex techniques and advanced equipment became available to treat chronically occluded coronary arteries. Such procedures portend a series of possible complications that operators should be ready to quickly recognize and deal with. Case summary A 75-year-old lady with uncontrolled stable angina underwent percutaneous treatment of a chronically occluded right coronary artery. After balloon angioplasty and stenting, she developed a severe hypotension, refractory to fluid resuscitation and vasopressors. Computerized tomography scan demonstrated an intramural haematoma (IMH) of the right atrioventricular groove resulting in life-threatening pseudotamponade (or dry tamponade), as further confirmed by cardiac magnetic resonance imaging (MRI). The decision was for conservative management and haemodynamic support by intra-aortic balloon pump. Clinically, the patient improved and was discharged a few days later. Follow-up MRI confirmed resolution of the IMH. Discussion Severe hypotension during percutaneous treatment of chronically occluded coronary arteries may be related to various causes. Differential diagnosis is thus important in this setting and should include IMH, a rare but potentially fatal complication as it may cause compression of cardiac chambers and lead to pseudotamponade. A high index of suspicion is required to diagnose IMH but there are no clear guidelines for management of such cases.

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Neutrophil extracellular traps induce MCP-1 release from endothelial cells at the plaque rupture site in acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3834 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Ondracek ◽

T.M Hofbauer ◽

A Mangold ◽

T Scherz ◽

V Seidl ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Endothelial Cells ◽

Plaque Rupture ◽

Ex Vivo ◽

Coronary Intervention ◽

Neutrophil Extracellular Traps ◽

Funding Source ◽

Extracellular Traps

Abstract Introduction Leukocyte-mediated inflammation is crucial in acute myocardial infarction (AMI). We recently observed that neutrophil extracellular traps (NETs) are increased at the culprit site, promoting activation and differentiation of fibrocytes, cells with mesenchymal and leukocytic properties. Fibrocyte migration is mediated by monocyte chemoattractant protein (MCP)-1 and C-C chemokine receptor type 2 (CCR2). We investigated the interplay between NETs, fibrocyte function, and MCP-1 in AMI. Methods Culprit site and femoral blood of AMI patients was drawn during percutaneous coronary intervention. We characterized CCR2 expression of fibrocytes by flow cytometry. MCP-1 and the NET marker citrullinated histone H3 (citH3) were measured by ELISA. Fibrocytes were treated in vitro with MCP-1. Human coronary arterial endothelial cells (hCAECs) were stimulated with isolated NETs, and MCP-1 was measured by ELISA and qPCR. The influence of MCP-1 on NET formation in vitro was assessed using isolated neutrophils. Results We have included 50 consecutive AMI patients into the study. NETs and concentrations of MCP-1 were increased at the CLS. NET stimulation of hCAECs induced MCP-1 on mRNA and protein level. Increasing MCP-1 gradient was associated with fibrocyte accumulation at the site of occlusion. In the presence of higher MCP-1 these fibrocytes expressed proportionally less CCR2 than peripheral fibrocytes. In vitro, MCP-1 dose-dependently decreased fibrocyte CCR2 and reduced ex vivo NET release of healthy donor neutrophils. Conclusions NETs induce endothelial MCP-1 release, presumably promoting a chemotactic gradient for leukocyte and fibrocyte migration. MCP-1 mediated inhibition of NET formation could point to a negative feedback loop. These data will shed light on vascular healing. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund

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The importance of early and late ventricular arrhythmias detection and prediction in acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1786 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Krljanac ◽

D Trifunovic ◽

M Asanin ◽

L Savic ◽

J Vratonjic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Poor Prognosis ◽

Longitudinal Strain ◽

Coronary Intervention ◽

Funding Source ◽

Clinical Center ◽

Percutaneous Coronary ◽

One Year

Abstract Background Malignant arrhythmias, ventricular tachycardia or ventricular fibrillation (VT/VF) in acute myocardial infarction (AIM) carry ominous prognosis including sudden cardiac death (SCD). It is not clear whether the timing of VT/VF occurrence always affects the poor prognosis of patients with AMI. Aim To investigate the prognosis of patients who undergoing primary percutaneous coronary intervention (PCI) in accordance with timing of VT/VF and to find the power predictors of their occurrence. Methods 307 consecutive patients in PREDICT-VT study (NCT03263949), 57.9±10.6 year old, 72.3% males were analysed. Of these patients, 27.7% had VT/VF from the symptoms onset, within 48 hours of AIM (early VT/VF group). 8.1% of patients had VT/VF after 48h, during one year follow up (late VT/VF group). Results The frequency of VT/VF occurrence was high between symptoms onset and the end of 2nd month and during 5th and 6th month of AIM. The parameters of conventional echocardiography were significantly impaired in late VT/VF group, as well as parameters of longitudinal strain (LS) (table). Moreover, the MACE (cardiovascular mortality, SCD, new infarction, emergency revascularisation, and hospitalized heart failure) was the highest in late VT/VF group (p=0.000). The most significant predictor of late VT/VF was systolic LS (cut off −12.72%, ROC 0.680, Sen 71%, Sp 64%, p=0.006). Conclusions Although late VT/VF occurrence after primary PCI were less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis. The most power predictor of late VT/VF were systolic longitudinal strain. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Clinical Center of Serbia

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Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman

Journal of International Medical Research ◽

10.1177/0300060520986680 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098668

Author(s):

Bo Pang ◽

Cong Hu ◽

Qian Liu ◽

Jinyu Yu ◽

Zhentong Wei ◽

...

Keyword(s):

Benign Tumors ◽

Free Fluid ◽

Adenomatoid Tumor ◽

Cancer Antigen 125 ◽

Immunohistochemical Markers ◽

Serum Ca125 ◽

Life Threatening ◽

Well Differentiated ◽

The Right

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor. The lesions may be single or multiple and usually behave in a benign or indolent fashion, sometimes persisting for many years. In the present case, a 37-year-old woman had experienced primary infertility for 12 years, and a diagnostic laparoscopy was performed. Approximately 200 mL of dark red, free fluid in the pelvis and more than 10 yellow-white nodules on the surface of the right round ligament, sacrum ligament, right fallopian tube, and both sides of the uterus were found. A lesionectomy was performed and immunohistochemical markers indicated WDPM with adenomatoid tumor. The patient was monitored by computed tomography and serum CA125 (cancer antigen 125) levels for 49 months with no recurrence. WDPM and adenomatoid tumor are both benign tumors of mesothelial origin. Because of the lack of effective radical treatment, regular follow-up is sufficient. However, the effects of estrogen and progesterone on WDPM and adenomatoid tumors during ovulation or pregnancy remains unclear. Although WDPM is not life threatening, a strategy to fulfill the fertility requirements of women with this condition is a new challenge for infertility doctors.

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Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1789 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Juskova ◽

P Tasende Rey ◽

B Cid Alvarez ◽

B Alvarez Alvarez ◽

J.M Garcia Acuna ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiogenic Shock ◽

Independent Predictor ◽

Coronary Intervention ◽

Prognostic Impact ◽

Cardiac Events ◽

Prognostic Information ◽

St Segment Elevation ◽

All Cause Mortality

Abstract Background The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed. Purpose This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile <38 (n=51), ≥38 SS-II intermediate tertile <47 (n=51), and SS-II high tertile ≥48 (n=51)]. Results Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001). The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000) Conclusion In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up. Image 1 Funding Acknowledgement Type of funding source: None

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Intra-Peritoneal Pseudocyst as a Rare Complication After Peritoneal Dialysis: The Use of a Staged Surgical Approach in Management

The American Surgeon ◽

10.1177/00031348211047465 ◽

2021 ◽

pp. 000313482110474

Author(s):

Ahmad Kharsa ◽

Kayla Colvill ◽

Heather Stevenson ◽

Jeffrey Fair ◽

Rupak Kulkarni ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Surgical Approach ◽

Rare Case ◽

Diagnostic Laparoscopy ◽

Rare Complication ◽

Cyst Excision ◽

Neoplastic Processes ◽

Life Threatening ◽

Pseudocyst Formation

Despite its numerous benefits, peritoneal dialysis (PD) can rarely result in dangerous and even life-threatening complications, including peritonitis, hernias, encapsulating peritoneal sclerosis (EPS), and rarely peritoneal pseudocysts. Herein, we present a rare case of a giant intra-peritoneal pseudocyst that presented four months following the discontinuation of a 5-year course of complicated PD. Despite the initially successful drainages, the patient’s symptoms continued to recur, and the imaging findings were concerning for underlying neoplastic processes. As such, a staged surgical approach was performed, starting with a diagnostic laparoscopy and was subsequently followed with cyst excision and marsupialization to the peritoneal cavity. While previous reports of such rare pseudocyst have been documented in the literature as a complication of PD, to our knowledge, this is the second case of pseudocyst formation to occur months after the discontinuation of PD therapy. This case emphasizes the importance of close follow-up in PD patients and showcases how a staged surgical approach can be utilized to accurately diagnose and manage such complicated cases.

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Abstract 2838: Sequential Changes of Left Ventricular Systolic and Diastolic Synchronicity in Acute ST-Elevation Myocardial Infarction after Primary Coronary Intervention

Circulation ◽

10.1161/circ.118.suppl_18.s_785 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Seong-Mi Park ◽

Yong-Hyun Kim ◽

Soon-Jun Hong ◽

Do-Sun Lim ◽

Wan-Joo Shim

Keyword(s):

Myocardial Infarction ◽

Wall Motion ◽

Chronic Phase ◽

Regional Wall Motion ◽

Coronary Intervention ◽

Left Ventricular ◽

Doppler Imaging ◽

Regional Wall ◽

St Elevation

The aims of this study were to assess the sequential changes of left ventricular (LV) systolic and diastolic synchronicity in patients with acute myocardial infarction (AMI) and to assess their relation with LV recovery and remodeling. Forty-patients with acute ST-elevation MI were examined within 2days, 6weeks and 6months after primary coronary intervention. Fifteen-age matched subjects were enrolled for normal control. The time from the onset of QRS complex to peak systolic velocity (Ts) and to peak early diastolic velocity (Te) were measured on color-coded tissue Doppler imaging. To assess LV synchronicity, SDs of Ts (Ts-SD) and Te (Te-SD) of all 12 segments were calculated (within 2days, at 6weeks and 6months; SD1, SD2 and SD3, respectively). LV recovery was defined as the improvement of wall motion at least more than two segments at 6 weeks. In all AMI patients, the wall motion score index was 1.72±0.27 and LV ejection fraction was 45.9±9.9%. The Ts-SD1 was higher in AMI patients than in controls (45.4±13.5 vs 29.4±13.3ms, p<0.05), but Te-SD1 was not different (18.7±6.9 vs 16.2±10.0). Twenty-two patients (group1) showed a recovery and 18 patients (group2) showed no recovery. The Ts-SD1 was smaller in group1 than in group2 (43.4±12.6 vs 47.9±11.7 ms, p<0.05). In group1, Ts-SD were much decreased as follow up (Ts-SD2, 3; 36.6±14.0 and 31.1±9.5, respectively, p<0.05). In contrast, in group2, Ts-SD was not significantly changed (Ts-SD2,3; 46.7±13.2 and 43.7±8.8, respectively) but Te-SD was increased as follow up (Te-SD1,2,3; 17.8±5.5, 20.4±4.3 and 25.0±3.8, respectively, p<0.05). The LV end-diastolic and systolic volume were increased and the deceleration time of early diastolic mitral inflow velocity was shortened in group2 (p<0.05). This clinical study shows: 1) in acute phase, the regional wall motion abnormalities of AMI had an impact on LV systolic synchronicity; 2) the AMI patients with LV recovery showed better LV systolic synchronicity; 3) the LV systolic synchronicity became better as regional wall motion was improved; and 4) in chronic phase, the LV diastolic synchronicity became worse in AMI patients with no recovery, which might be related to LV remodeling and worsening of LV diastolic function.

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