CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg Rep 2017; 06(01): e5-e9
DOI: 10.1055/s-0037-1601315
Case Report: Cardiac
Georg Thieme Verlag KG Stuttgart · New York

Myocardial Ischemia Caused by Subepicardial Hematoma

Philippe Grieshaber
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
Holger Nef
2   Department of Cardiology and Angiology, University Hospital of Giessen, Giessen, Germany
Andreas Böning
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
Bernd Niemann
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
› Author Affiliations
Further Information

Publication History

03 December 2016

17 February 2017

Publication Date:
24 March 2017 (online)


Background Bleeding from bypass anastomosis leakage occurs early after coronary artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous bleeding is unlikely.

Case Description A 63-year-old male patient developed a pseudoaneurysm-like, subepicardial late-term bleeding resulting in a hematoma that compromised coronary artery flow by increasing extracoronary pressure. This resulted in severe angina pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the affected area. After surgical removal of the hematoma and repair of the anastomosis, the patient's symptoms disappeared and no signs of myocardial ischemia were present.

Conclusion Surgical removal is an efficient therapy for subepicardial hematoma inducing myocardial ischemia.

  • References

  • 1 Shavadia J, Norris CM, Graham MM, Verma S, Ali I, Bainey KR. Symptomatic graft failure and impact on clinical outcome after coronary artery bypass grafting surgery: results from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry. Am Heart J 2015; 169 (06) 833-840
  • 2 Dacey LJ, Munoz JJ, Baribeau YR. , et al; Northern New England Cardiovascular Disease Study Group. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Arch Surg 1998; 133 (04) 442-447
  • 3 Hosono M, Ueda M, Suehiro S. , et al. Neointimal formation at the sites of anastomosis of the internal thoracic artery grafts after coronary artery bypass grafting in human subjects: an immunohistochemical analysis. J Thorac Cardiovasc Surg 2000; 120 (02) 319-328
  • 4 Furushima H, Matsubara T, Tamura Y. , et al. Coronary artery perforation with subepicardial hematoma. Cathet Cardiovasc Diagn 1997; 41 (01) 59-61
  • 5 Quan VH, Stone JR, Couper GS, Rogers C. Coronary artery perforation by cutting balloon resulting in dissecting subepicardial hematoma and avulsion of the vasculature. Catheter Cardiovasc Interv 2005; 64 (02) 163-168
  • 6 Holinski S, Konertz W, Beholz S. Covered perforated aortocoronary saphenous vein graft aneurysm. J Card Surg 2009; 24 (01) 91-93
  • 7 Ariyama J, Imanishi H, Nakagawa H, Kitamura A, Hayashida M. Epicardial hematoma and myocardial ischemia following application of Starfish stabilizer: an uncommon complication of the device. J Anesth 2010; 24 (05) 801-802
  • 8 Szalat A, Durst R, Cohen A, Lotan C. Use of polytetrafluoroethylene-covered stent for treatment of coronary artery aneurysm. Catheter Cardiovasc Interv 2005; 66 (02) 203-208
  • 9 Stone GW, Goldberg S, O'Shaughnessy C. , et al. 5-year follow-up of polytetrafluoroethylene-covered stents compared with bare-metal stents in aortocoronary saphenous vein grafts the randomized BARRICADE (barrier approach to restenosis: restrict intima to curtail adverse events) trial. JACC Cardiovasc Interv 2011; 4 (03) 300-309