RESUMO
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.
Assuntos
Traumatismos Cardíacos/complicações , Técnicas Hemostáticas/efeitos adversos , Hérnia/etiologia , Hipotensão/etiologia , Toracotomia/efeitos adversos , Ferimentos Perfurantes/complicações , Adulto , Pressão Sanguínea , Procedimentos Cirúrgicos Cardíacos , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/fisiopatologia , Traumatismos Cardíacos/cirurgia , Coração Auxiliar , Hérnia/diagnóstico , Hérnia/fisiopatologia , Hérnia/terapia , Humanos , Hipotensão/diagnóstico , Hipotensão/fisiopatologia , Hipotensão/cirurgia , Miocárdio Atordoado/etiologia , Miocárdio Atordoado/fisiopatologia , Miocárdio Atordoado/cirurgia , Pericardiocentese , Resultado do Tratamento , Função Ventricular , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/fisiopatologia , Ferimentos Perfurantes/cirurgiaRESUMO
With a small left ventricular aneurysm, the surgeon finds it difficult to decide whether to repair the aneurysm or leave it alone; there are risks and benefits to consider. Our choice is plication rather than resection. The procedure may be performed on-pump or off-pump, and the results are easy to demonstrate with the help of transesophageal echocardiogram.
