Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury

Sugimoto, Satoru; Yamashita, Akio; Baba, Masahito; Izumiyama, O; Hasegawa, Tadashi

doi:10.1007/bf03217937

Cited by 4 publications

(1 citation statement)

References 10 publications

(7 reference statements)

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“…While the most common venous variation identified in 3-6% of cases is location of a segmental vein traversing posterior to the bronchus intermedius (which must be recognized during subcarinal lymph node dissection), up to 30% of patients may have significant venous variation, including a common ostium of the upper and lower lobe veins, particularly on the left (7)(8)(9). Given this significant degree of variability, recommendations from some authors have advised routine formal preoperative assessment of venous pulmonary vasculature with computed tomography prior to all resections (10 …”

Section: Preoperative Radiologic Assessment Of Vascular and Anatomic mentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/ or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injuryspecific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches. hemorrhage within moments. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. When they do occur, premeditated and expedited intervention is the key to rescue (1). The current report focuses on the prevention and management of these emergency bleeding events in VATS pulmonary resections. Preoperative radiologic assessment of vascular and anatomic variationRigorous preoperative evaluation of fitness of surgery is a key component of any operative assessment. Preoperative identification and awareness of case-specific and patientspecific risk factors may help prevent hemorrhagic complications in most lung resections. These factors include body habitus, preoperative chemotherapy and radiation, bleeding diatheses including medical anticoagulants, previous thoracic surgery, lymph node calcification and/or granulomatous disease, tumor size and location.Computed chest tomography has become a standard of care in virtually all cases considered for major pulmonary resection. These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2-6). Imaging may also identify cal...

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Section: Preoperative Radiologic Assessment Of Vascular and Anatomic mentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Traumatic ciardiac rupture with acute ascites

Koyama

Miyamoto

Murakami

et al. 2000

Jpn J Thorac Caridovasc Surg

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A rare accumulation of serous ascites following traumatic cardiac rupture is reported for a 21-year-old man transferred to the emergency center of our hospital from a community hospital suffering from severe shock due to a motorcycle accident. Computed tomography scan showed moderate pericardial and intrapelvic fluid accumulation strongly suggesting cardiac and visceral injuries. An emergency sternotomy disclosed a rupture of the right atrial appendage, successfully closed with primary sutures. A laparotomy was done to aspirate moderate serous fluid, which was clear and not bloody. Edema of the retroperitoneal space and hepatic congestion were noted with no accompanying organ injury. Ascites pathogenesis is unknown but appeared to be related to portal venous congestion induced by cardiac tamponade combined with massive intravenous fluid infusion done to correct the patient's deteriorating hemodynamics.

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Delayed blow-out type rupture of the right ventricle following blunt chest trauma

Murai¹,

Saito

Chiba

et al. 2003

Jpn J Thorac Caridovasc Surg

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A 36-year-old man suffered multiple traumatic injuries when he fell from a crane. Fractures of both lower extremities, a compression fracture of the fourth lumbar vertebra, and bilateral hemopneumothoraxes were identified. The sternum was not fractured, but was tender. The day after admission, the right ventricular free wall ruptured and was diagnosed by echocardiography. An emergency operation was performed. A Gore-tex sheet was sutured from inside the ventricle, and a Hemashield graft was sutured over the tear. The risk of hemorrhage is high in the patient with multiple traumatic injuries when heparin is required. Mechanical ventilation was required until the 13th postoperative day because persistent hemothorax. After an operation to reduce a leg fracture, the patient was discharged from the hospital on the 66th postoperative day.

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Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury

Cited by 4 publications

References 10 publications

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Traumatic ciardiac rupture with acute ascites

Delayed blow-out type rupture of the right ventricle following blunt chest trauma

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