Department of Cardiac Anaesthesia, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
Department of Cardiothoracic and Vascular Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
Ann Card Anaesth. 2021 Apr-Jun;24(2):234-237. doi: 10.4103/aca.ACA_170_19.
We report a case of 44-year-old female patient with congenital heart disease, ostium secundum atrial septal defect (ASD) with moderate mitral regurgitation for minimally invasive ASD repair along with mitral valve repair. Venous cannulations were performed through right internal jugular vein and right femoral vein (RFV) and arterial cannulation was accomplished through right femoral artery. Intraoperative transesophageal echocardiography (TEE) could not visualize venous cannula through RFV. However, cardiopulmonary bypass (CPB) was initiated and surgery was proceeded. During surgery, patients abdomen became tense and distened, ontable ultrasound examination of abdomen was done after completion of the surgery to rule out hemoperitoneum but was inconclusive, patient was evaluated further under fluoroscopy in cathlab and found to have interrupted inferior vena cava. Postoperative course of the patient was uneventful. We discuss the importance of preoperative evaluation and the role of TEE in placement of cannulas during minimally invasive cardiac surgery.
我们报告了 1 例 44 岁女性患者，患有先天性心脏病，房间隔缺损（ASD）继发孔型，伴中度二尖瓣关闭不全，行微创 ASD 修补术联合二尖瓣修复术。静脉插管通过右颈内静脉和右股静脉（RFV）进行，动脉插管通过右股动脉完成。术中经食管超声心动图（TEE）无法通过 RFV 可视化静脉插管。然而，心肺转流（CPB）已经启动，手术继续进行。在手术过程中，患者腹部紧张膨胀，手术完成后进行了腹部床旁超声检查以排除腹腔积血，但结果不确定，随后在导管室透视下对患者进行了进一步评估，发现下腔静脉中断。患者术后恢复顺利。我们讨论了术前评估的重要性以及 TEE 在微创心脏手术中放置插管的作用。
