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Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?
A Arbulu1, E Gursel, L G Camero
1Division of Cardiothoracic Surgery, Wayne State University, Detroit, Michigan 48201, USA.
Summary
Cardiac surgery patients with mediastinitis or sternal dehiscence faced a rare risk of right ventricle (RV) rupture. Freeing the RV during sternal debridement may prevent this life-threatening complication.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Complications
Background:
- Mediastinitis and sternal dehiscence are known complications following cardiac surgery.
- A retrospective review of 10,263 cardiac surgery patients (1979-1993) identified 1.4% with these complications.
- Treatment involved mediastinal drainage, sternal debridement, and wound closure with muscle flaps.
Observation:
- Seven patients (0.07%) experienced massive hemorrhage due to anterior right ventricle (RV) wall tears between debridement and wound closure.
- Bleeding was temporarily controlled with direct pressure, followed by surgical repair.
- Six of the seven affected patients survived after RV repair, with some requiring femoral-femoral bypass.
Findings:
- Right ventricle rupture is a rare but severe complication associated with sternal debridement for mediastinitis/dehiscence.
- The proposed mechanism involves sternal edges avulsing the anterior RV surface adhered to the sternum.
- Early identification and RV repair are crucial for patient survival.
Implications:
- Releasing the right ventricle from the sternum during initial debridement is a critical preventive measure.
- This simple maneuver could significantly reduce the incidence of RV rupture post-cardiac surgery.
- Adopting this technique may improve outcomes for patients undergoing sternal wound management.