Intramyocardial hematoma after coronary perforation during percutaneous coronary intervention--anticipated and treated.

Coronary perforation is an uncommon complication of percutaneous coronary intervention and the subset of patients developing a subepicardial hematoma without hemopericardium is even rarer. Subepicardial (or intramyocardial) hematomas are often associated with catastrophic events. These hematomas are reported mainly in those with prior coronary artery bypass grafting (CABG). To date, only 2 cases have been reported in non-CABG patients. Ours is such a case where the perforation failed to resolve. Despite the absence of pericardial effusion or hemodynamic instability, we anticipated the possibility of a dissecting myocardial hematoma and proceeded with preemptive surgery. Perioperative findings confirmed the presence of a large intramyocardial hematoma, conservative treatment of which may well have led to potentially lethal consequences. We then review the scant literature on the subject.