Staged Management of Left Atrial Intramural Hematoma with Extracorporeal Membrane Oxygenation Support: A Case Report

Left atrial intramural hematoma (LAIH) is a rare complication related to various cardiac interventions, including cardiac surgery, catheter-based arrhythmia ablation, and percutaneous coronary intervention (PCI), all of which may involve manipulation of the left atrium (LA). Here, we describe the challenging management of a patient who developed LAIH after PCI. A 72-year-old male patient was transferred to our hospital for the management of LAIH after PCI. Owing to cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) was initiated. Repeat coronary angiography confirmed perforation of the left circumflex coronary artery; thus, coil embolization was performed. Subsequently, emergency surgical evacuation of the LA hematoma was performed to relieve the hemodynamic instability and impaired intracavitary flow. ECMO was weaned the day after surgery, and the patient made a full recovery. Even in critically ill patients, staged management with ECMO support should be considered to facilitate recovery.