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Left atrial rupture during on-pump beating coronary artery bypass grafting
Hideaki Hidaka1, Tatsuaki Sadanaga2, Takafumi Hirota2
1Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan. hidaka.hideaki@kuh.kumamoto-u.ac.jp.
Insights
Left atrial rupture is an extremely rare complication during on-pump beating coronary artery bypass grafting (CABG). This case highlights the need for cardiac arrest and potential mitral annuloplasty for repair of this serious injury.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Complications
Background:
- On-pump beating coronary artery bypass grafting (CABG) is utilized for patients with impaired cardiac function.
- Left atrial injury during CABG is uncommon, with no prior reports linked to on-pump beating techniques.
Purpose of the Study:
- To report a rare case of left atrial rupture during on-pump beating coronary artery bypass grafting (CABG).
Main Methods:
- An 80-year-old male with severe coronary artery disease underwent conversion from off-pump to on-pump beating CABG due to circulatory instability.
- During the procedure, a 5-cm left atrial laceration occurred near the mitral annulus.
- Repair involved cardiac arrest, bovine pericardial patch closure, and simultaneous mitral annuloplasty.
Main Results:
- The patient experienced a sudden, severe bleed from the left atrium during cardiac manipulation.
- Successful hemostasis was achieved after arresting the heart and repairing the atrial laceration.
- The patient recovered uneventfully following the complex surgical repair.
Conclusions:
- Left atrial rupture during on-pump beating CABG is an exceedingly rare event.
- Atrial wall damage is hypothesized to result from cardiac displacement and mitral regurgitant jet impact.
- Surgical repair necessitates cardiac arrest, and mitral annuloplasty may be an adjunct procedure.
Background:
On-pump beating coronary artery bypass grafting (CABG) is a procedure that uses cardiopulmonary bypass to maintain circulation and it is a useful technique for CABG in patients with severely impaired cardiac function. Here, we report a case of left atrial rupture that occurred during CABG. Reports of left atrial injury are rare, and there have been no previous reports of such cases associated with on-pump beating CABG.
Case Presentation:
An 80-year-old man with a history of myocardial infarction was admitted to another hospital for acute heart failure. Coronary angiography revealed triple-vessel disease, and echocardiography showed reduced left ventricular function and moderate mitral regurgitation. He was transferred to our hospital for coronary artery bypass grafting and the operation was scheduled. Surgery was started with the intention of off-pump CABG, but due to circulatory instability, the patient was converted to on-pump beating CABG. While the heart was being dislocated and anastomosis was being performed, sudden bleeding from the left atrium occurred. To achieve hemostasis, we needed to arrest the patient's heart. A 5-cm laceration along the posterior mitral annulus was found in the left atrium and repaired with a bovine pericardial patch. Mitral annuloplasty with a flexible ring was performed simultaneously. He recovered uneventfully.
Conclusions:
The left atrial rupture during on-pump beating coronary artery bypass grafting is extremely rare. The wall of the atrium is thought to have been damaged by the stress applied during the displacement of the heart and the impact of the enlarged mitral regurgitant jet. Repair under cardiac arrest is necessary, and in some cases, mitral annuloplasty may be additionally required.
