Fatal haemorrhage following intra-aortic balloon counterpulsation: a case report and a brief review of its clinico-pathological and medico-legal aspects.

Intra-aortic balloon counterpulsation may result in serious and possibly fatal vascular complications, such as arterial dissection, in as many as 20 per cent of cases. A significant proportion of these complications may go unrecognized clinically. The following is an account of such a case from Singapore in which an elderly patient with a history of severe ischaemic heart disease died within 25 hours of coronary bypass surgery (resulting from massive intraperitoneal haemorrhage), as a consequence of post-operative intra-aortic balloon counterpulsation. The clinico-pathological and medico-legal aspects of the case are also discussed, together with a brief mention of the role of post-mortem coronary angiography in assessing venous graft patency and integrity.