CC-BY-NC-ND 4.0 · THORAC CARDIOV SURG Reports 2017; 06(01): e5-e9
DOI: 10.1055/s-0037-1601315
Case Report: Cardiac
Georg Thieme Verlag KG Stuttgart · New York

Myocardial Ischemia Caused by Subepicardial Hematoma

Philippe Grieshaber1, Holger Nef2, Andreas Böning1, Bernd Niemann1
  • 1Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen, Giessen, Germany
  • 2Department of Cardiology and Angiology, University Hospital of Giessen, Giessen, Germany
Further Information

Publication History

03 December 2016

17 February 2017

Publication Date:
24 March 2017 (online)


Background Bleeding from bypass anastomosis leakage occurs early after coronary artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous bleeding is unlikely.

Case Description A 63-year-old male patient developed a pseudoaneurysm-like, subepicardial late-term bleeding resulting in a hematoma that compromised coronary artery flow by increasing extracoronary pressure. This resulted in severe angina pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the affected area. After surgical removal of the hematoma and repair of the anastomosis, the patient's symptoms disappeared and no signs of myocardial ischemia were present.

Conclusion Surgical removal is an efficient therapy for subepicardial hematoma inducing myocardial ischemia.