Acute Intramyocardial Right Ventricular Hematoma After Coronary Artery Bypass Graft.

A 50-year-old woman underwent coronary artery bypass graft (CABG) for multivessel coronary artery disease. Due to hemodynamic instability, the patient could not be weaned from cardiopulmonary bypass without mechanical support, even after multiple attempts. Subsequently, a right ventricular intramyocardial hematoma (IH) was found during postoperative coronary angiography. The IH was felt to be the main contributing factor leading to right ventricular failure and cardiogenic shock, which, to the authors' knowledge, has not been previously reported after CABG. An IH is a rare complication postoperatively that often requires a high level of suspicion to identify on transesophageal echocardiogram. It should be suspected when there is hemodynamic instability intraoperatively or postoperatively in the intensive care unit that cannot be explained easily. There currently is no standard treatment. Treatment often is based on the individual patient and degree of hemodynamic instability.

Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery.

The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established.