Pericardial Tamponade due to Perforation of a Posterolateral Branch of the Circumflex Artery Caused by a Perforating Edge of a Resected Rib following Orthopedic Surgery in a 14-Year-Old Patient
DOI:
https://doi.org/10.1532/HSF98.20101020Abstract
A 14-year-old female patient with Marfan syndrome was resuscitated because of pericardial tamponade following orthopedic surgery to correct scoliosis. The emergency sternotomy revealed injury to a posterolateral branch of the circumflex artery caused by pericardial perforation by the stump of a previously resected rib. Cardiopulmonary bypass immediately restored the circulation, and the primarily dilated, noncontractile heart regained its contractile function. The small posterolateral branch was sewn over, and the sharp edge of the rib stump was smoothed by abrasion and covered with a Gore-Tex membrane. The patient recovered completely during the remainder of her postoperative stay.References
Goodsett JR, Pahl AC, Glaspy JN, Schapira MM. 1999. Kirschner wire embolization to the heart: an unusual cause of pericardial tamponade. Chest 115:291-3.nGrieve P. 2006. Cardiac perforation secondary to a fractured rib sustained in a ram attack in New Zealand: a review of ovine fatalities and an important lesson regarding the severely injured chest. N Z Med J 119:U2315.nHeini P, Schöll E, Wyler D, Eggli S. 1998. Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report. Spine 23:2226-30.nOnda H, Kaminishi Y, Misawa Y, Fuse K. 2003. Non-perforating pericardial rupture causing cardiac tamponade. Interact Cardiovasc Thorac Surg 2:43-5.nPollak S, Stellwag-Carion C. 1991. Delayed cardiac rupture due to blunt chest trauma. Am J Forensic Med Pathol 12:153-6.nRoth T, Kipfer B, Takala J, Schmid RA. 2002. Delayed heart perforation after blunt trauma. Eur J Cardiothorac Surg 21:121-3.nTesterman GM. 2006. Surgeon-performed ultrasound in the diagnosis and management of pericardial tamponade in a 20-month-old blunt injured toddler. Tenn Med 99:37-8, 41.nTubbax H, Hendzel P, Sergeant P. 1989. Cardiac perforation after Kirschner wire migration. Acta Chir Belg 89:309-11.n