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Case Reports
. 2024 May 20:11:1331873.
doi: 10.3389/fcvm.2024.1331873. eCollection 2024.

Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report

Mohammadbagher Sharifkazemi  1 , Mohammad Ghazinour  2 , Mehrzad Lotfi  3 , Soorena Khorshidi  1 , Tahereh Davarpasand  4
Affiliations
Case Reports

Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report

Mohammadbagher Sharifkazemi et al. Front Cardiovasc Med. .

Abstract

Myocardial infarction is among the top causes of mortality worldwide. Survivors may also experience several complications. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardial infarction, coronary artery bypass graft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications. Ventricular tachyarrhythmias, including TdP, because of electrical inhomogeneity, would potentially be a lethal complication of CABG. Here, we report the occurrence of medically intractable TdP in the presence of an uncommon case of a post-CABG retrosternal hematoma. Arrhythmia was properly resolved after hematoma removal surgically. It showed the possibility of a "cause and effect" relationship between these two complications. This unique case emphasizes the post-CABG medically-resistant TdP, considering the mechanical pressure effect of retrosternal hematoma that stimulates this potentially malignant arrhythmia, especially in the absence of electrolyte disturbances and evident symptoms of ongoing ischemia.

Keywords: cardiac tamponade; case report; coronary artery bypass; myocardial infarction; torsades de pointes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The first ECG on arrival and before CABG, which illustrates normal sinus rhythm with low voltage QRS and prolonged qTcB (505 ms), in addition to findings compatible with inferolateral STEMI.
Figure 2
Figure 2
The tracing shows bigeminal PVBs with short coupling intervals (R on T), which degenerated into torsade de pointes.
Figure 3
Figure 3
(A) Post-contrast axial CT scan image during pulmonary arterial phase, which shows high soft tissue density lesion in the anterior mediastinum with hounsfiled unit (HU) consistent with clotted blood (HU = 81). Also note the presence of mild left-sided bloody pleural effusion (HU = 45), associated with the underlying collapse of the posterior basal segment of the left lower lobe and a lesser degree of segmental atelectasis of the posterior basal segment of the right lower lobe, all secondary to recent CABG operation. (B) MPR images show narrowing of RVOT secondary to external pressure effect by retrosternal hematoma (arrows).
See this image and copyright information in PMC

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