Onitsuka Hirofumi, Miyamoto Kazuyuki
Department of Cardiovascular Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan.
Kyobu Geka. 2022 Mar;75(3):224-227.
A 62-year-old woman had a history of catheter ablation three times in the past for atrial fibrillation underwent the fourth catheter ablation. Atrial septum was punctured by Brockenbrough procedure. Two 8 Fr sheaths were inserted into left atrium. But blood was not drawn from the sheaths, and right atrial imaging confirmed that sheaths penetrated into cardiac sac. Pericardial fluid gradually increased and state of shock was seen due to cardiac tamponade. Drainage was performed through sheaths and hemodynamic condition was stabilized. It was judged that urgent surgical repair was necessary. When cardiopulmonary bypass was attached and right atrial incision was made under cardiac arrest, two sheaths were piercing from right atrial to pericardial transverse sinus on the dorsal side of ascending aorta. After removing the sheaths, the perforation was closed directly inside and outside right atrial wall. The postoperative course was generally good.
一名62岁女性既往有3次房颤导管消融病史,此次接受第4次导管消融。采用布罗肯布罗 procedure 穿刺房间隔。将两根8F鞘管插入左心房。但鞘管未抽出回血,右心房造影证实鞘管穿入心包腔。心包积液逐渐增多,因心脏压塞出现休克状态。通过鞘管进行引流,血流动力学状况得以稳定。判断有必要进行紧急手术修复。在心脏停搏下建立体外循环并做右心房切口时,发现两根鞘管从右心房穿至升主动脉背侧的心包横窦。拔出鞘管后,直接对右心房壁内外的穿孔进行缝合。术后病程总体良好。 (注:原文中“Brockenbrough procedure”未明确具体含义,可能是特定医学操作名称,暂按原样保留)