Cooley-Rieders Keaton, Donayre Carlos E, Nelson Ariana M
School of Medicine, University of California at Irvine, Irvine, CA, USA.
School of Medicine, University of California at Irvine, Orange, CA, USA.
J Surg Case Rep. 2020 Sep 24;2020(9):rjaa368. doi: 10.1093/jscr/rjaa368. eCollection 2020 Sep.
Perioperative cardiac tamponade during central venous catheter placement is rare. We present a case of tamponade from pulmonary artery injury during dialysis catheter placement resulting in complicated sternotomy and hospital course. A 52-year-old female experienced intraoperative hypotension, rapidly identified as tamponade, that was treated with an emergent paramedian sternotomy. Patient experienced postdischarge dehiscence and osteomyelitis requiring multiple reoperations. This case is the first report of a deviated paramedian sternotomy performed mainly through ribs. The complications experienced outline the importance of effective multidisciplinary knowledge of best practices to stabilize tamponade pathology, mitigating morbidity and mortality.
中心静脉导管置入过程中围手术期心脏压塞很少见。我们报告一例在透析导管置入期间因肺动脉损伤导致心脏压塞的病例，该病例导致了复杂的胸骨切开术及住院过程。一名52岁女性在术中出现低血压，很快被确定为心脏压塞，通过紧急旁正中胸骨切开术进行了治疗。患者出院后出现切口裂开和骨髓炎，需要多次再次手术。本病例是首例主要通过肋骨进行的偏离旁正中胸骨切开术的报告。所经历的并发症凸显了有效掌握最佳实践的多学科知识对于稳定心脏压塞病理状况、降低发病率和死亡率的重要性。
