ABSTRACT
Respiratory failure after Ivor-Lewis esophagectomy results in poor outcomes. Limited treatment strategies are available to manage this severe complication. One possibility is extracorporeal support. We report the successful use of extracorporeal support as a successful strategy for refractory respiratory failure.
Subject(s)
Adenocarcinoma/surgery , Esophageal Neoplasms/surgery , Esophagectomy/methods , Extracorporeal Membrane Oxygenation , Humans , Male , Middle AgedABSTRACT
A 31-year-old woman was admitted to the emergency department with a stab wound to the heart. She was initially stable but rapidly developed hypotension. While the operating room and staff were in preparation, she underwent pericardiocentesis. She was then rushed to the operating room by the general surgical trauma team, who performed a bilateral anterior thoracotomy to control the bleeding. In the recovery room, the patient was still hypotensive, so cardiothoracic surgery was consulted. An echocardiogram revealed severe hypokinesis of both ventricles. The cardiothoracic surgeons returned her to the operating room and discovered that the anterior pericardium had been completely removed by the trauma team. This had caused the posterior pericardium to form a "bowstring" that almost totally obstructed pulmonary venous return and restricted right ventricular outflow of blood, inducing right-sided heart failure. This pericardial string also strangulated the left atrium posteriorly, forming 2 compartments. We repositioned the patient's heart and implanted ventricular assist devices bilaterally to provide temporary circulatory support. The patient made a good recovery. We suggest that bilateral assist device placement can be beneficial in the recovery of a stunned but otherwise normal heart.
Subject(s)
Heart Injuries/complications , Hemostatic Techniques/adverse effects , Hernia/etiology , Hypotension/etiology , Thoracotomy/adverse effects , Wounds, Stab/complications , Adult , Blood Pressure , Cardiac Surgical Procedures , Echocardiography, Transesophageal , Female , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/surgery , Heart Injuries/diagnosis , Heart Injuries/physiopathology , Heart Injuries/surgery , Heart-Assist Devices , Hernia/diagnosis , Hernia/physiopathology , Hernia/therapy , Humans , Hypotension/diagnosis , Hypotension/physiopathology , Hypotension/surgery , Myocardial Stunning/etiology , Myocardial Stunning/physiopathology , Myocardial Stunning/surgery , Pericardiocentesis , Treatment Outcome , Ventricular Function , Wounds, Stab/diagnosis , Wounds, Stab/physiopathology , Wounds, Stab/surgerySubject(s)
Cardiomyopathy, Hypertrophic/diagnosis , Heart Aneurysm/diagnostic imaging , Heart Ventricles/pathology , Noonan Syndrome/diagnosis , Ventricular Outflow Obstruction/diagnostic imaging , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/physiopathology , Child , Echocardiography, Doppler/methods , Heart Aneurysm/complications , Heart Aneurysm/physiopathology , Humans , Magnetic Resonance Imaging/methods , Noonan Syndrome/complications , Rare Diseases , Ventricular Outflow Obstruction/complications , Ventricular Outflow Obstruction/physiopathologyABSTRACT
We report a case of a 22-year-old patient with a severe form of hypertrophic cardiomyopathy involving both ventricles, for which he underwent surgical treatment. Echocardiogram and magnetic resonance imaging confirmed the presence of an aneurysm in the inferior-anterior portion of the right ventricle.
