Intraoperative Cardiac Free Wall Rupture
Free wall rupture...yes we can save them
Following a syncope event, a 72-y old male was brought to the ER, stable on arrival with no history of cardiac diseases, ECG showed normal sinus rhythm, ST depression and elevated Troponin T. The patient described back pain 3 days prior with no other complaints.
ECHO revealed pericardial effusion, CT ANGIO ruled out aortic dissection while pericardial effusion and an infract of the LV at Circumflex territory were noticed.
Therefore, the patient was taken to the OR for post MI free wall rupture repair.
As expected at induction the patient collapsed and the team had to crash into the chest. Once the pericardium was opened, and the clots and blood were evacuated (tamponade was relived) no hemodynamically recovery occurred.
As continuous red (and not dark) blood was still accumulating, the heart was lifted and the tear seen in Video was spotted.
CPB was commenced and the heart was arrested for repair.
The tear was repaired using felt strips and a few single 4-0 prolene, sewing healthy tissue to healthy tissue, going beyond the infract and taking big “bites”; a pericardial patch and bio-glue were used as a second layer.
Once no bleeding was confirmed the patient was weaned from CPB and brought to the ICU.
The patient was discharged home 10 days post-op in good condition with no neurological damage.
- Dr. Yaron Barac @BaracYaron
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