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Right ventricular rupture in minimally invasive direct coronary artery bypass grafting
1Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Japan.
Insights
A rare right ventricle rupture occurred during minimally invasive direct coronary artery bypass grafting (MIDCABG) redo surgery. Excessive pericardial traction during dissection may cause cardiac rupture.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anatomy
- Surgical Complications
Background:
- Minimally invasive direct coronary artery bypass grafting (MIDCABG) is a less invasive approach for coronary artery revascularization.
- Redo bypass surgery presents unique challenges due to potential adhesions and altered anatomy.
- The left internal thoracic artery (LITA) to the left anterior descending artery (LAD) is a common bypass conduit.
Observation:
- A 52-year-old male patient undergoing redo MIDCABG experienced an unexpected rupture of the right ventricle.
- The rupture occurred during the dissection phase while identifying the left anterior descending artery (LAD).
- The surgical team noted excessive dissection in the interventricular groove with undue traction on the pericardium.
Findings:
- Right ventricular rupture is a rare but serious complication during cardiac surgery.
- The specific mechanism involved aggressive dissection and pericardial traction.
- This event highlights the delicate nature of cardiac structures during redo procedures.
Implications:
- Surgeons must exercise extreme caution during dissection in redo MIDCABG, particularly around the interventricular groove.
- Careful management of pericardial traction is crucial to prevent iatrogenic injury.
- Awareness of this rare complication is important for risk mitigation in complex cardiac surgeries.
Abstract:
We report a rare case of the rupture of the right ventricle which occurred in a minimally invasive direct coronary artery bypass grafting (MIDCABG) for a redo bypass surgery. A 52-year-old male patient underwent a left internal thoracic artery (LITA) to the left anterior descending artery (LAD) bypass. Rupture of the right ventricle occurred abruptly during dissection to find the LAD. Too much dissection of the interventricular groove under undue traction of the pericardium may cause a rupture of the heart.