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doi:10.1093/ehjci/jev102 Online publish-ahead-of-print 30 April 2015

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Aortic valve haematoma as a complication after coronary angiography: a clinical case with spontaneous resolution M.J. Sanchez Galian1, M.J. Oliva-Sandoval1, J.A. Castillo2, S. Manzano-Ferna´ndez3, and G. de la Morena1* 1 Servicio de Cardiologı´a, Unidad de Imagen, IMIB-Arrixaca, Carretera Madrid Cartagena s/n, Murcia CP 30120, Spain; 2Servicio de Cardiologı´a, University Hospital of Santa Lucia, Cartagena, Murcia, Spain; and 3Servicio de Cardiology, IMIB-Arrixaca, School of Medicine, Murcia, Spain

* Corresponding author. Tel: +34 968369484. E-mail: [email protected]

Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected]

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A 39-year-old man consulted for palpitations. The ECG showed a regular monomorphic tachycardia with inferior axis and left bundle branch block morphology. The arrhythmia was successfully treated with electrical cardioversion in emergency room. Afterwards, physical examination, laboratory testing, ECG, transthoracic echocardiogram, and coronary angiography were carried out with no abnormalities. Forty-eight hours after the coronary angiogram, a transthoracic echocardiogram showed a thick and restricted non-coronary cusp of the aortic valve (arrow in Panel A). Subsequently, a 2D (Panel B) and 3D transoesophageal echocardiography (Panel C and Movies I and II) confirmed the presence of a low-density mass involving the noncoronary leaflet (10 × 10 mm) and an increased thickness of the posterior aortic root wall (arrows in Panels B and C ). These findings were similar to a case previously described with anatomical diagnosis of iatrogenic haematoma of the aortic root. In our case, neither significant gradient nor regurgitation was detected. Patient was clinically stable, and we opted for a conservative management approach. A transthoracic echocardiogram performed 10 days later demonstrated a complete resolution of the haematoma (Panel D). To the best of our knowledge, we present the first case of an iatrogenic haematoma involving an aortic valve cusp, which resolves spontaneously. There is no information about the prognosis of such a complication. Only one case was described previously. In this case, the affected was the right coronary cusp with a life-threatening clinical course due to the occlusion of the right coronary ostium. Emergent surgically management was required.

Aortic valve haematoma as a complication after coronary angiography: a clinical case with spontaneous resolution.

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