Author + information
- Received November 6, 2012
- Revision received November 20, 2012
- Accepted November 27, 2012
- Published online July 16, 2013.
- Jen-Li Looi, MB, ChB∗,
- Alex Pui-Wai Lee, MB, ChB∗,
- Chin-Pang Chan, MB, ChB∗,
- Joseph Yat-Sun Chan, MB, ChB∗,
- Anna Kin-Yin Chan, MB, ChB∗,
- Mable Tong, MB, ChB†,
- Ka-Tak Wong, MB, ChB† and
- Cheuk-Man Yu, MB, ChB, MD∗
A 52-year-old woman became hypotensive during radiofrequency ablation for paroxysmal atrial fibrillation. She received heparin 5,000 IU after transseptal puncture, and continued as an infusion to maintain an activated clotting time of 270 s during the procedure. Focused transthoracic echocardiography revealed a left atrial (LA) mass suspicious of a thrombus. Computed tomography showed a large LA hematoma that was thought to be extracardiac and compressing on the LA (A). Echo 3 days later revealed a well-circumscribed mass in the posterior wall of the LA (B), highly suggestive of an intramural hematoma. Follow-up echo 2 weeks later demonstrated that the hematoma had evolved into a cyst-like structure (C), suggesting a partially resolved hematoma, with the dissection flap in the LA wall clearly visualized. Contrast echocardiography excluded communication between the intramural cavity and the LA (D, Online Video 1). Anticoagulation was stopped until the repeat echo 2 months later (E) demonstrated a significant reduction in the size of the hematoma. The patient remained well clinically, thus no further intervention was taken.
Dr. Looi acknowledges support from the Overseas Fellowship Award from the National Heart Foundation New Zealand. Dr. Lee is a consultant for Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 6, 2012.
- Revision received November 20, 2012.
- Accepted November 27, 2012.
- American College of Cardiology Foundation