[HSF] A case: cardiac rupture

[Ani Anyanwu]

One option which I have never tried but which was suggested to me after we had a cardiac rupture a day after a seemingly successful intraoperative repair, is to place an LVAD to offload the ventricle. With an LVAD the LV pressures will become same as LA pressure and the low pressure will place less strain on repair site, allowing healing to take place. Off course the question would be when one would consider it safe to explant the LVAD.

Ani
  ----- Original Message ----- 
  From: Dr. Roberto Battellini<mailto:battr at medizin.uni-leipzig.de> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> ; 'Open'<mailto:Heart-L- at lists.hsforum.com> 
  Sent: Wednesday, October 18, 2006 11:06 AM
  Subject: [HSF] A case: cardiac rupture


  Dear Members,

   

  Woman born  1952, was  studied In a foreign Hospital  because of
  haemopericardium of unknown origin. CT: No dissection, haemopericardium.
  There she was  punctured and send then  to HZL.   In Leipzig she got ECG ,
  almost normal, CKMB normal, troponin was not done, and went directly to cath
  lab: LAD 99% stenotic, RCA 2-3 stenosis 70%, CX 50%. She got another
  punction for tamponade, unsuccessful. Then the interventionist, under
  reanimation,   called me for inferior drainage. I did a  5 cm incision and
  drained it ( lot of clots and 200 blood). With good pressure, I send her to
  OR. During the transport, she was  again 2 times reanimated.  In OR, we put
  her on pump. The aorta was ok. I closed 3 bleeding sites. One at the
  marginal angle of RV,  and two bleeding strongly between Diagonal and obtuse
  marginal branches. These were stitched with 4/0 Prolene with pledget. Also
  there was a haematoma in the region of the sulcus, at the region  of  AV
  groove. I thought as diagnosis   1. status after heart reanimation or 2.
  acute infarction. I added   2 vein bypasses   to LAD and PD. (no mammary
  because of reanimation and sternal fracture). If it was an infarction, why
  there, the CX was only 50% stenosed!.  I added glue and tachosyl as for a
  coronary sinus rupture. 

  After going out off bypass, came blood from the sutured zone, where the
  pledgets were stitched, now the muscle looked a little disrupted. . Again 20
  minutes on bypass, I added 2 teflon felt strips sutured with 3/0 Prolene as
  it were an aneurysma. It Bleeded diffuse, again Bioglue, etc. I added an
  IABP as she was long reanimated and got That suture.  Quick time was 7%. I
  left the chest open and with packing, she received everything to favour
  coagulation, inclusive factor 7.  At night she was reoperated by Michael
  Borger, he had to stitch again with Teflon, again packing. Bleeding stopped
  12 hours after. The ventricle had good contractions on echo. No more
  bleeding. One day after (may be a decision  error) ,she was again reoperated
  with intention to close the chest. After taking out the gauzes she began to
  bleed again. We poured 3 pistols of bioglue and tabotamp and so on. Bleeding
  stopped and the chest was left open. At night the heart ruptured , she was
  carried gain to OR, and there  died there at 3.00 AM. 

  Questions: experience from the members, what would have done different those
  with experience, etc.

  Diagnosis: 1.
  infarction->haemopericardium->puntions->tamponade->reanimation->cardiac
  rupture, etc against    2. other cause of haemopericardium and the rest is
  iatrogenic.

  Roberto 

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