Ventricular Non-compaction
Jan Kaehler, A. Schuchert, Ralf Koester, Florian M. Wagner, Hermann Reichenspurner, Thomas Meinertz
University Hospital Hamburg, Department of Cardiology, Martinistrasse 52, 20246 Hamburg, Germany
A 54-year-old male was transferred to our institution for treatment of symptomatic pericardial effusion of unknown origin. The past medical history included surgical closure of a ventricular septal defect 32 years ago, insulin-dependent diabetes mellitus and chronic hepatitis C infection. The patient had been admitted for angina-like symptoms 20 hours earlier but acute myocardial infarction could be ruled out by EKG and laboratory work-up. Thoracic CT scan revealed a right-sided pericardial effusion of 2cm width.
During coronary angiography in our institution, the patient turned bradycardic and a temporary pacer was inserted. Following subsequent contrast injection without any manipulation in the right coronary artery, arterial pressure decreased rapidly and cardiopulmonary resuscitation had to be performed. Echocardiography revealed an almost complete compression of the right ventricle by haematoma and fresh blood, the patient was therefore transferred under continuing cardiopulmonary resuscitation to the operating theatre. After installation of femoro-femoral extracorporeal circulation, surgical exploration revealed a large, partially organized haematoma and adhesions due to the previous surgery adjacent to the right ventricle but no coronary aneurysm. Bleeding could be traced to a small ruptured epicardial artery that was sutured with pledged-armed prolene. Following haemostasis and removal of the haematoma, the patient was successfully weaned from the extracorporeal circulation and recovered completely within nine days. In the post-operative work-up, no specific aetiology of the coronary rupture could be determined. Follow-up angiography revealed a completely normal coronary anatomy without any stenoses.
Figure legend
Injection into the right coronary artery in the right anterior oblique projection. A small postero-lateral branch leaks into an egg-shaped contrast dye deposit, which was part of a layered haematoma as discovered upon surgical exploration. The size of the haematoma can be anticipated by the contrast extensions at 12, 4, 6 and 10 o’clock of the contrast deposit.
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