Hargrove M, Marshall C B, Jahanjir S, Hinchion J
Cardiothoracic Surgery Unit, Cork University Hospital, Wilton, Cork, Ireland.
Perfusion. 2010 Nov;25(6):423-4. doi: 10.1177/0267659110381154. Epub 2010 Aug 10.
A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.
一名34岁男性因阵发性房颤接受经皮心房消融术，因心脏压塞需紧急行胸骨切开术。该患者在消融术前及术中均接受了抗凝治疗，并服用了波立维和阿司匹林。在心脏导管室已输注了7单位红细胞浓缩液。到达手术室时，患者血压低，但麻醉诱导时清醒。无创监测未测得可记录的血压。立即行胸骨切开术，打开心包后未见出血部位。患者开始进行体外循环。确定出血部位并封闭缺损。患者在最小的正性肌力支持下脱离体外循环，恢复顺利。体外循环时间为38分钟。文献回顾显示消融术后出血发生率为1%（1）。此前尚未报道过因此类事件重新进行体外循环的发生率。在这些手术过程中，在心脏导管室进行心房消融术时通知心胸外科团队可能是明智的。
