HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arbulu, A. Articles by Stephenson, L. W. Search for Related Content PubMed PubMed Citation Articles by Arbulu, A. Articles by Stephenson, L. W.

European Journal of Cardio-Thoracic Surgery, Vol 10, 110-115, Copyright © 1996 by European Association for Cardio-thoracic Surgery

ARTICLES

Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?

A Arbulu, E Gursel, LG Camero, I Asfaw and LW Stephenson
Division of Cardiothoracic Surgery, Wayne State University, Detroit, Michigan 48201, USA.

Mediastinitis and/or sternal dehiscence developed in 143 out of 10,263 patients (1.4%) who underwent cardiac surgery between January 1979- December 1993. Mediastinal drainage, sternal debridement and early wound closure with pectoralis major and/or rectus abdominalis muscle flaps was the treatment employed. Between these two stages of treatment, massive hemorrhage developed in seven patients (0.07%) from a tear of the anterior wall of the right ventricle (RV). Six patients survived. Temporary control of the bleeding was achieved with digital or full palm pressure control of the ventricular tear. This was followed by immediate repair in the operating room (OR). The only death was due to exsanguination in the intensive care unit. The other six patients were taken to the OR. The anterior RV was freed from the underside of the sternum and the RV tear repaired with or without the aid of femoral-femoral bypass. These six then had muscle flap wound closures at that time or shortly after. All six were hospital survivors and are currently alive. We believe that RV rupture results from the sternal edges pulling the anterior surface of the RV apart, since the RV is stuck to the underside of the sternum. This experience indicates that the RV must be freed in all cases during initial sternal debridement. Hopefully this simple maneuver will prevent this horrendous complication.

This article has been cited by other articles:

				J. Sjogren, M. Malmsjo, R. Gustafsson, and R. Ingemansson Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 898 - 905. [Abstract] [Full Text] [PDF]

				S. S. Bhavani, W. Slisatkorn, S. J. Rehm, and G. B. Pettersson Deep sternal wire infection resulting in severe pulmonary valve endocarditis. Ann. Thorac. Surg., September 1, 2006; 82(3): 1111 - 1113. [Abstract] [Full Text] [PDF]

				T. Hakala, L. Berg, E. Berg, K. Makinen, and P. Sipola Repair of Right Ventricular Free Wall Defect With a De-Epithelized Pedicled Myocutaneous Latissimus Dorsi Muscle Flap Ann. Thorac. Surg., December 1, 2005; 80(6): 2360 - 2362. [Abstract] [Full Text] [PDF]

				Y. Abu-Omar, M. J. Naik, P. A. Catarino, and C. Ratnatunga Right ventricular rupture during use of high-pressure suction drainage in the management of poststernotomy mediastinitis Ann. Thorac. Surg., September 1, 2003; 76(3): 974 - 974. [Full Text] [PDF]

				A. Yellin, Y. Refaely, M. Paley, and D. Simansky Major bleeding complicating deep sternal infection after cardiac surgery J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 554 - 558. [Abstract] [Full Text] [PDF]

				V. Vijay and J. P. Gold Late Complications of Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 521 - 537. [Full Text]

				D. H. Pelsue, E. Monnet, J. S. Gaynor, B. E. Powers, K. Halling, D. Parker, and A. Golden Closure of Median Sternotomy in Dogs: Suture Versus Wire J. Am. Anim. Hosp. Assoc., November 1, 2002; 38(6): 569 - 576. [Abstract] [Full Text] [PDF]

				T. Szerafin, O. Jaber, and A. Peterffy Repair of right ventricular rupture complicating mediastinitis. Ann. Thorac. Surg., November 1, 1999; 68(5): 1892 - 1893. [Full Text] [PDF]