Successful Rescue from Cardiac Arrest in a Patient with Postinfarction Left Ventricular Blow-Out Rupture: "Extra-Pericardial Aortic Cannulation" for Establishment Total Cardiopulmonary Bypass

Authors

  • Suguru Ohira
  • Hitoshi Yaku
  • Shunsuke Nakajima
  • Akihiko Takahashi

DOI:

https://doi.org/10.1532/HSF98.2014351

Abstract

We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.

References

Ayyash B, Tranquilli M, Elefteriades JA. 2011. Femoral artery cannulation for thoracic aortic surgery: safe under transesophageal echocardiographic control. J Thorac Cardiovasc Surg. 142(6):1478-81.nKato Y, Fukui T, Tabata M, Takanashi S. 2013. Successful infarct exclusion for postinfarction left ventricular free wall rupture. Interact CardioVasc Thorac Surg 16:900-902.nMoreno R, Lopez de SE, Lopez-Senden JL, Garcia E, Soriano J, Abeytua M, et al. 2000. Frequency of left ventricular free-wall rupture in patients with acute myocardial infarction treated with primary angioplasty. Am J Cardiol 85:757-60.nSakamoto S, Taniguchi N, Nakajima S, Takahashi A. 2012. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome. Ann Thorac Surg 94(1):1-7.n

Published

2014-09-01

How to Cite

Ohira, S., Yaku, H., Nakajima, S., & Takahashi, A. (2014). Successful Rescue from Cardiac Arrest in a Patient with Postinfarction Left Ventricular Blow-Out Rupture: "Extra-Pericardial Aortic Cannulation" for Establishment Total Cardiopulmonary Bypass. The Heart Surgery Forum, 17(4), E217-E219. https://doi.org/10.1532/HSF98.2014351

Issue

Section

Articles