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Contained rupture of right ventricular outflow tract after Rastelli-type operation

Takuji Watanabe1, Kyoichi Nishigaki1, Yoichi Kawahira1

  • 1Department of Pediatric Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan.

Cardiology in the Young
|January 10, 2020
PubMed

Insights

A rare case of a child with post-operative mediastinitis developed a contained right ventricular rupture, presenting as a chest wall bulge. Severe adhesions surprisingly maintained stable hemodynamics despite the rupture.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Medical Imaging

Background:

  • Post-operative mediastinitis can lead to severe cardiac complications.
  • Rupture of the right ventricle is a life-threatening event, often resulting in rapid hemodynamic compromise.

Observation:

  • A 3-year-old infant presented with mediastinitis following surgery.
  • A significant finding was a large, pulsating prominence on the anterior chest wall, indicative of a contained rupture.
  • Computed tomography (CT) revealed a direct blood pathway from the right ventricular outflow tract to a cavity within the pectoral musculocutaneous flap.

Findings:

  • The contained rupture of the right ventricle was successfully identified and characterized.
  • Severe adhesions between the right ventricle and the surrounding musculocutaneous flap were noted.
  • These adhesions were crucial in maintaining the patient's hemodynamic stability despite the cardiac rupture.

Implications:

  • This case highlights the potential for unusual presentations of cardiac injuries post-surgery.
  • It underscores the importance of advanced imaging like CT in diagnosing complex post-operative complications.
  • The findings suggest that adhesions, while often problematic, can sometimes play a protective role in specific clinical scenarios, offering insights into cardiac repair and stability.

Keywords:
CTPost-operative mediastinitisRastelli-type operationcontained rupturemusculocutaneous flapright ventricular outflow tract

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