RESUMO
BACKGROUND: Iatrogenic hemorrhagic pericardial tamponade (IHPT) represents a life-threating condition requiring emergency pericardiocentesis. In this clinical context, reinfusion of pericardial blood can stabilize the patient and sustain hemodynamic conditions. AIMS AND METHODS: We reviewed all cases of IHPT occurred at our hospital over a 10 years span. In all patient autologous blood reinfusion through a femoral vein was performed. RESULTS: In our clinical experience of 30 consecutive patients with hemorrhagic cardiac tamponade, this technique was successful to limit blood transfusions, to prevent further clinical worsening and bridge patients with intractable bleeding, to cardiac surgery. No major adverse reactions were directly related to blood autotransfusion. CONCLUSION: In the complex clinical scenario of acute tamponade occurring during catheter-based cardiac procedures, autotransfusion of pericardial blood through a femoral vein is safe and effective. It can be a useful trick up the sleeve of the interventional cardiologist.
Assuntos
Transfusão de Sangue Autóloga , Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/terapia , Veia Femoral , Hemorragia/terapia , Doença Iatrogênica , Pericardiocentese , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue Autóloga/efeitos adversos , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Estudos de Viabilidade , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pericardiocentese/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
We herein report the case of an ST-elevation myocardial infarction due to bioresorbable vascular scaffold (BRS) failure. Optical coherence tomography (OCT) revealed the exact mechanism of late BRS stent thrombosis due to an acquired coronary aneurysm related to BRS. A drug eluting OCT-guided stenting over a failed BRS in the context of an acute coronary syndrome, with the simultaneous presence of a BRS thrombosis and coronary artery aneurysm, proved to be effective.
Assuntos
Síndrome Coronariana Aguda/cirurgia , Aneurisma Coronário/etiologia , Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Everolimo/farmacologia , Intervenção Coronária Percutânea/efeitos adversos , Alicerces Teciduais/efeitos adversos , Síndrome Coronariana Aguda/diagnóstico , Aneurisma Coronário/diagnóstico , Angiografia Coronária , Vasos Coronários/cirurgia , Feminino , Humanos , Imunossupressores/farmacologia , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Reoperação , Tomografia de Coerência ÓpticaRESUMO
We report the case of a myocardial infarction in the post-partum period due to a spontaneous coronary artery dissection. The role of intracoronary imaging was critical: OCT imaging led us to formulate the right diagnosis.OCT imaging revealed a multiple coronary artery dissection in the left main non-detectable on angiography and in the circumflex, with evidence of coronary hematoma in the circumflex and left anterior descending. Beside dissection, OCT showed evidence of a thrombus near the coronary tear in the left main. Our invasive OCT-based strategy proved to be non-harmful and gave an excellent clinical result in the clinical context of a spontaneous multivessel coronary dissection with left main involvement in a rare connective tissue disorder.
