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.