Abstract
Backgroud: Local blood clots in the pericardium are a common complication after coronary artery bypass grafting (CABG). However, it is very rare to clinical present with persistent ST-segment elevation. To date, there have been no reported cases. Case presentation: A 54-year-old male was admitted due to exertional angina. Three-vessel coronary artery disease was initially diagnosed based on Coronary angiography. The patient underwent a selective three coronary artery bypass graft (CABG) and extracted the tube the next day. But, on the second postoperative day, type I respiratory failure and type 5 myocardial infarction were diagnosed based on elevated ST segment, high-sensitivity troponin T and decreased P02 (55mmHg). The patient was given intravenous nitroglycerin and invasive mechanical ventilation. Despite these interventions, the patient's condition deteriorated on the third postoperative day. Cardiac tamponade was diagnosed based on clinical presentation and echocardiography. He underwent an emergency procedure for retrograde pericardial effusion drainage, which led to a rapid improvement in his clinical symptoms. Unfortunately, the patient subsequently developed acute hepatic and renal failure. A rethoracotomy was performed on the fifth postoperative day, which showed a large amount of blood clots on the pericardial surface and partial occlusion of the inferior vena cava reflux. The patient 's condition improved significantly and the elevated ST segment returned to normal after the surgery. On the tenth day after reoperation, laboratory tests such as liver function, renal function, and troponin T returned to normal. The patient was discharged fourteen days after the reoperation. Conclusion: Persistent ST-segment elevation as a rare but easily detectable clinical presentation of of pericardial local blood clots after CABG.