Surgery following Extracorporeal Cardiopulmonary Resuscitation in a Patient with an Extracardiac Rupture of Valsalva Sinus Aneurysm
DOI:
https://doi.org/10.1532/hsf.2325Abstract
The rupture of sinus of Valsalva aneurysm (SVA) into the pericardial cavity is extremely rare and fatal. A 52-year-old man presented with an abrupt onset of chest pain and dizziness. An echocardiography and a computed tomographic angiography revealed a giant aneurysm of the noncoronary sinus (NCS) (maximum, 70 mm) and pericardial effusion in favor of tamponade with a moderate degree of aortic insufficiency. On the way to the operating room, he suffered cardiac arrest, and extracorporeal cardiopulmonary resuscitation (ECPR) was initiated immediately. While he was prepared for surgery, the patient was supported by extracorporeal life support (ECLS) until cardiopulmonary bypass (CPB) was initiated. The sinus defect was reconstructed using a Dacron patch, followed by resection of the aneurysm. ECLS and CPB were discontinued successfully in the operating room. This study reports a case of an extracardiac rupture of SVA and the successful completion of surgery following ECPR.
References
Buxton AE, Goldberg S, Harken A, Hirshfield J Jr, Kastor JA. 1981. Coronary-artery spasm immediately after myocardial revascularization: recognition and management. N Engl J Med 304:1249-53.
Buxton AE, Hirshfeld Jr JW, Untereker WJ, et al. 1982. Perioperative coronary arterial spasm: long term follow-up. Am J Cardiol 50:444-51.
Gaetano AL, Giulia Careri, Filippo Crea. 2011. Mechanisms of coronary artery spasm. Circulation 124:1774-82.
He GW, Taggart DP. 2016. Antispastic management in arterial grafts in coronary artery bypass grafting surgery. Ann Thorac Surg 102:659-68.
Lemmer JH Jr, Kirsh MM. 1988. Coronary artery spasm following coronary artery surgery. Ann Thorac Surg 46:108-15.
Marques KM, Jensen EE, Huybregts RA. 2006. Profound coronary spasm caused by a mediastinal draining tube. Heart 92:514.
Mayumi H, Kawachi Y, Kohno H, et al. 1994. Drug infusion through a branch of the aortocoronary vein graft for refractory coronary spasm. Ann Thorac Surg 54:869-71.
Pichard AD, Ambrose J, Mindich B, et al. 1980. Coronary artery spasm and perioperative cardiac arrest. J Thorac Cardiovasc Surg 80:249-54.
Schena S, Wildes T, Beardslee MA, Lasala JM, Damiano RJ Jr, Lawton JS. 2007. Successful management of unremitting spasm of the nongrafted right coronary artery after off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 133:1649-50.
Teragawa H, Nishioka K, Fujii Y, et al. 2014. Worsening of coronary spasm during the perioperative period: A case report. World J Cardiol 6:685-8.
