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Retropericardial hematoma complicating off-pump coronary artery bypass surgery
Toshihiro Fukui1, Shigefumi Suehiro, Toshihiko Shibata
1Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan. tm-fukui@gem.hi-ho.ne.jp
Insights
A rare retropericardial hematoma occurred after off-pump coronary artery bypass grafting, compressing the heart and impairing function. Pulmonary vein injury and heparin were likely causes of this serious complication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Case Reports
Background:
- Off-pump coronary artery bypass grafting (OPCAB) is a surgical technique to bypass blocked coronary arteries without using cardiopulmonary bypass.
- While generally safe, OPCAB procedures can carry risks, including rare but serious complications.
- Retropericardial hematomas are collections of blood in the space behind the pericardium, a sac surrounding the heart.
Observation:
- A patient developed a retropericardial hematoma following triple-vessel OPCAB surgery.
- Transesophageal echocardiography revealed the hematoma compressing the left atrium and reducing cardiac function.
- The hematoma was located in the retropericardial space.
Findings:
- The retropericardial hematoma was identified as the cause of cardiac compression and dysfunction.
- Potential etiologies identified include injury to a pulmonary vein during deep pericardial suturing.
- Postoperative administration of heparin was also considered a contributing factor.
Implications:
- This case highlights a rare but potentially fatal complication associated with OPCAB surgery.
- Awareness of this complication is crucial for cardiac surgeons performing OPCAB procedures.
- Prompt diagnosis and management are essential for improving patient outcomes in such cases.
Abstract:
We report the case of a retropericardial hematoma after triple-vessel off-pump coronary artery bypass grafting. Transesophageal echocardiography demonstrated a retropericardial hematoma that compressed the left atrium anteriorly and suppressed cardiac function. Injury to the pulmonary vein during placement of deep pericardial sutures and postoperative infusion of heparin were the likely causes of this rare but potentially fatal complication of an off-pump bypass operation.