Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
J Cardiothorac Surg. 2021 Apr 15;16(1):88. doi: 10.1186/s13019-021-01478-y.
Rapid growth of cardiac wall hematoma is a rare but potentially fatal complication of cardiac surgery. However, its pathophysiology and optimal management remain undefined.
Here we present a rare case of a large cardiac wall hematoma in the right ventricle during a thoracic aortic and valvular surgery. The hematoma expanded rapidly with epicardial rupture during cardiopulmonary bypass. We could establish non-surgical hemostasis and prevent further expansion of hematoma by early weaning of the cardiopulmonary bypass, followed by the administration of protamine and manual compression by hemostatic agent application. His postoperative recovery was uneventful and upon computed tomography analysis, the hematoma was observed to have absorbed completely at 1 week postoperatively. The patient is doing well 1 year after the surgery without evidence of recurrent cardiac wall hematoma on follow-up computed tomography.
Cardiovascular surgeons should bear in mind this potentially catastrophic complication during cardiac surgery. Because of the vulnerability of the cardiac wall at the area of the hematoma, we believe that a hemostatic approach without sutures may be effective for this lethal complication.
心脏壁血肿的快速增长是心脏手术的一种罕见但潜在致命的并发症。然而，其病理生理学和最佳治疗方法仍未确定。
在这里，我们介绍了一例在胸主动脉和瓣膜手术期间右心室巨大心脏壁血肿的罕见病例。在体外循环期间，血肿在外膜破裂时迅速扩大。我们通过早期停止体外循环、给予鱼精蛋白和使用止血剂手动按压来实现非手术止血，并防止血肿进一步扩大。他的术后恢复顺利，在术后 1 周的计算机断层扫描分析中，血肿完全吸收。术后 1 年，患者情况良好，在随访计算机断层扫描中未发现心脏壁血肿再次出现。
心血管外科医生在心脏手术中应牢记这种潜在的灾难性并发症。由于血肿部位的心脏壁脆弱，我们认为不使用缝线的止血方法可能对这种致命并发症有效。
