Author + information
- Hiroko Kamitani1
Patient initials or identifier number
Relevant clinical history and physical exam
A 58-year-old man presented with dyspnea and loss of appetite. Massive lung cancer and pericardial effusion were detected in his CT findings and the symptoms were considered to be due to cardiac tamponade. Urgent pericardial drainage was done. 200 mL of bloody fluid was drained immediately. Once the drainage was effective in blood pressure and heart rate, however he collapsed suddenly after 6 hours from pericardial drainage with acute chest pain. His systolic pressure decreased to 40 mmHg.
Relevant test results prior to catheterization
Pericardial effusion was not increased in his UCG and his ECG showed ST elevation in inferior leads. Thus we performed emergent catheterization.
Relevant catheterization findings
CAG showed RCA was almost occluded by eccentric lesion of ostium. Coronary dissection, plaque rupture and thrombus were not detected.
At first, we thought coronary spastic angina occurred because there was no evidence of stenosis and thrombus in CAG and IVUS findings. After infusion of nitrate via guiding catheter to RCA and making sure that TIMI3 flow was maintained, guide wire and catheter was removed. Suddenly, he presented chest pain and ST elevation was detected again. CAG showed total occlusion of RCA ostium. Thus, we decided to deploy the bare metal stent in RCA ostium. We thought that the cause of acute occlusion of RCA was changes of the heart structure due to pericardial drainage, because the event occurred after drainage of malignant pericardial effusion with the sign of adherent pericardium in UCG. After stenting in RCA, coronary flow was maintained without wire and guide catheter and his chest pain was never detected.
Stenting was effective for total occlusion of RCA ostium caused by changes of the heart structure due to pericardial drainage. When the drainage for malignant pericardial effusion is planned, it may be useful to check the sign of adherent pericardium for predicting MI occurring in this mechanism.