Discussion
Intramural hematoma is an uncommon cause of LA mass [1]. There have
been several reports of LA IMH occurring as a complication of PCI and
ablation [1-5].
Because the clinical course and outcome of LA IMH are poorly understood,
no definitive criteria exist to guide the management of this rare
entity. In case of hemodynamic stability, conservative management should
be selected [3]; otherwise, surgical treatment should be chosen if
patient is hemodynamically unstable. Hemodynamic instability is mainly
caused by functional MS.
Jothidasan et al. reported a case of LA IMH that was successfully
treated by surgically removing the clot [6]. In that case, the
patient had undergone CABG 19 years ago; therefore, an anterolateral
thoracotomy approach with small incision of the LA was selected. Cresce
et al. reported good results of surgical treatment of LA IMH with mitral
annular detachment, which was caused by the dissection of the atrial
wall [7]. In these case reports, no additional treatment for
coronary artery perforation was performed after evacuation of the
hematoma. We performed angiography after surgery to detect the cause of
LA IMH, and found continuous extravasation from the LCX. We believe that
a combination of surgery and interventional therapy should be considered
to prevent the recurrence of LA IMH. Moreover, long-term follow-up
should be performed, even if early postoperative hemodynamic status is
stable.