27793101 Visualization

A 70 Age - year Age - old Age male Sex was admitted Clinical_event to our hospital for perioperative Detailed_description cardiac Diagnostic_procedure evaluation Diagnostic_procedure of abdominal Biological_structure aortic Biological_structure aneurysm Disease_disorder .
The patient had undergone coronary Therapeutic_procedure artery Therapeutic_procedure bypass Therapeutic_procedure grafting Therapeutic_procedure ( CABG Therapeutic_procedure ) for severe Severity stenosis Sign_symptom of the left Biological_structure main Biological_structure coronary Biological_structure artery Biological_structure ( LMCA Biological_structure ) 4 Date years Date before Date , which consisted of the right Biological_structure internal Biological_structure thoracic Biological_structure artery Biological_structure ( RITA Biological_structure ) to the left Biological_structure anterior Biological_structure descending Biological_structure artery Biological_structure ( LAD Biological_structure ) and saphenous Therapeutic_procedure vein Therapeutic_procedure graft Therapeutic_procedure ( SVG Therapeutic_procedure ) to the left Biological_structure circumflex Biological_structure artery Biological_structure ( LCX Biological_structure ).
Due to continual growth of the abdominal Biological_structure aortic Biological_structure aneurysm Disease_disorder over the years, surgery Therapeutic_procedure was indicated.
Left Biological_structure coronary Biological_structure angiogram Diagnostic_procedure showed 90 Lab_value % Lab_value stenosis Sign_symptom of the LMCA Biological_structure and total Severity occlusion Sign_symptom of both Detailed_description grafts Coreference .
PCI Therapeutic_procedure was performed for LMCA Biological_structure stenosis Sign_symptom (Fig.1).
A 7 Detailed_description - Fr Detailed_description sheath Therapeutic_procedure was inserted into the right Biological_structure femoral Biological_structure artery Biological_structure , and a CLS4 Detailed_description guiding Detailed_description catheter Therapeutic_procedure ( Boston Detailed_description Scientific, Detailed_description Natick, Detailed_description MA, Detailed_description USA Detailed_description ) was engaged into the left Biological_structure coronary Biological_structure artery Biological_structure ( LCA Biological_structure ) ostium Biological_structure .
A guidewire Therapeutic_procedure ( SION Detailed_description Blue Detailed_description , Asahi Detailed_description Intecc, Detailed_description Aichi, Detailed_description Japan Detailed_description ) was inserted into the distal Biological_structure LAD Biological_structure , and another guidewire Therapeutic_procedure ( Hi Detailed_description - Torque Detailed_description Pilot Detailed_description 50 Detailed_description , Abbott Detailed_description Vascular, Detailed_description Santa Detailed_description Clara, Detailed_description California, Detailed_description USA Detailed_description ) was inserted into the distal Biological_structure LCX Biological_structure .
Intravascular Diagnostic_procedure ultrasound Diagnostic_procedure ( IVUS Diagnostic_procedure ) ( Intra Detailed_description - focus Detailed_description WR Detailed_description , Terumo Detailed_description Corp, Detailed_description Tokyo, Detailed_description Japan Detailed_description ) demonstrated heavy Severity circumferential Detailed_description calcification Sign_symptom in the LMCA Biological_structure lesion Sign_symptom .
After a 4.0 Detailed_description   × Detailed_description   15 Detailed_description - mm Detailed_description Quantum Detailed_description Maverick Detailed_description balloon Detailed_description catheter Therapeutic_procedure ( Boston Detailed_description Scientific Detailed_description ) was inflated in the lesion Sign_symptom , LCA Biological_structure angiogram Diagnostic_procedure revealed a large Severity dissection Sign_symptom (Fig.2).
A 4.0 Detailed_description   × Detailed_description   28 Detailed_description - mm Detailed_description Multi Detailed_description - Link Detailed_description Vision Detailed_description stent Therapeutic_procedure ( Abbott Detailed_description Vascular Detailed_description ) was immediately deployed.
Angiographic Diagnostic_procedure image of the residual Detailed_description dissection Sign_symptom disappeared and the stent Therapeutic_procedure was dilated by a 5.0 Detailed_description   × Detailed_description   15 Detailed_description - mm Detailed_description Quantum Detailed_description Maverick Detailed_description balloon Therapeutic_procedure catheter Therapeutic_procedure .
The absence of residual Detailed_description dissection Sign_symptom was confirmed by angiography Diagnostic_procedure after stent Therapeutic_procedure implantation.
Next, LMCA Biological_structure - LAD Biological_structure and LMCA Biological_structure - LCX Biological_structure kissing Detailed_description balloon Detailed_description angioplasty Therapeutic_procedure was initiated using a 4.0 Detailed_description   × Detailed_description   28 Detailed_description - mm Detailed_description stent Detailed_description delivery Detailed_description balloon Therapeutic_procedure in the LAD Biological_structure and a 3.0 Detailed_description mm Detailed_description   × Detailed_description   15 Detailed_description - mm Detailed_description Ikazuchi Detailed_description balloon Therapeutic_procedure ( Kaneka Detailed_description Medics, Detailed_description Tokyo, Detailed_description Japan Detailed_description ) in the LCX Biological_structure .
The final angiographic Diagnostic_procedure imaging showed optimal Lab_value results Diagnostic_procedure , and IVUS Diagnostic_procedure imaging of the lesion Sign_symptom showed completely Lab_value sealing Diagnostic_procedure by the stent Therapeutic_procedure (Fig.3).
A large Severity hematoma Sign_symptom at the femoral Biological_structure puncture Biological_structure site Biological_structure and local Detailed_description bleeding Sign_symptom was observed after removal of the femoral Therapeutic_procedure sheath Therapeutic_procedure and manual Therapeutic_procedure compression Therapeutic_procedure was applied for haemostasis Therapeutic_procedure .
The hematoma Sign_symptom did not appear to have spread the Date next Date day Date and the patient was discharged Clinical_event from the hospital Nonbiological_location on the fifth Date day Date after Date PCI Therapeutic_procedure .
Unexpectedly, the patient was admitted Clinical_event to our emergency Nonbiological_location room Nonbiological_location with new-onset chest Biological_structure pain Sign_symptom and dyspnoea Sign_symptom the next Date day Date after Date the discharge Clinical_event .
His vital Diagnostic_procedure signs Diagnostic_procedure indicated cardiogenic Sign_symptom shock Sign_symptom .
Electrocardiogram Diagnostic_procedure showed ST Sign_symptom elevation Sign_symptom in leads Diagnostic_procedure V1 Diagnostic_procedure - V3 Diagnostic_procedure .
Although echocardiography Diagnostic_procedure could not detect left Biological_structure ventricular Biological_structure asynergy Sign_symptom , a large mass Sign_symptom on the outflow Biological_structure tract Biological_structure of Biological_structure right Biological_structure ventricular Biological_structure chamber Biological_structure was observed (Fig.4).
Contrast Detailed_description - enhanced Detailed_description computed Diagnostic_procedure tomography Diagnostic_procedure showed a 40 Distance - mm Distance hematoma Sign_symptom compressing Sign_symptom the main Biological_structure pulmonary Biological_structure artery Biological_structure trunk Biological_structure and the right Biological_structure ventricle Biological_structure (Fig.5).
During examination Diagnostic_procedure , the patient suffered sudden Detailed_description cardiopulmonary Disease_disorder arrest Disease_disorder .
He received immediate Detailed_description cardiopulmonary Therapeutic_procedure resuscitation Therapeutic_procedure and returned to spontaneous Sign_symptom circulation Sign_symptom after the insertion of a percutaneous Detailed_description cardiopulmonary Therapeutic_procedure support Therapeutic_procedure device Therapeutic_procedure .
The patient underwent emergent Detailed_description surgery Therapeutic_procedure for the removal of the hematoma Sign_symptom after informed consent was obtained from the patient's family.
During surgery Therapeutic_procedure , large Severity , dark Color red Color clots Sign_symptom between the pulmonary Biological_structure artery Biological_structure trunk Biological_structure and aorta Biological_structure were observed.
The suspected origin of the epicardial Biological_structure hematoma Sign_symptom was blood Sign_symptom oozing Sign_symptom from the LMCA Biological_structure stent Biological_structure site Biological_structure .
Despite successful surgical Therapeutic_procedure repair Therapeutic_procedure , the patient died Outcome from aortic Disease_disorder rupture Disease_disorder induced by external Therapeutic_procedure cardiac Therapeutic_procedure massage Therapeutic_procedure .