Secondary abdominal compartment syndrome required decompression laparotomy during minimally invasive mitral valve repair

Abstract

We treated a 77-year-old patient with secondary abdominal compartment syndrome that caused failure to maintain cardiopulmonary bypass while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repair procedures. During the operation, a decompression laparotomy was needed to relieve elevated intraabdominal pressure that caused instability of the cardiopulmonary bypass. Due to poor oxygenation and the long cardiopulmonary bypass time, the patient required peripheral extracorporeal membrane oxygenation before recovery. We alert surgeons to this rare complication that can occur even in patients undergoing minimally invasive surgery with a right mini-thoracotomy.

Automated Intra-abdominal Pressure Monitoring During Orthotopic Heart Transplant Leads to Early Diagnosis and Treatment of Intraoperative Abdominal Compartment Syndrome—A Case Report

“…Recently, a prospective observational multicenter study reported one percent of cardiac surgery patients developed ACS post-operatively and require decompressive laparotomy, with significant associated mortality of 57% ( 13 ). We could only identify two prior case reports describing the development of intraoperative ACS during cardiac surgery: (1) secondary ACS during failure to maintain CPB while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repairs ( 14 ). In this report, the authors reported a “relatively long period of time was needed to make a diagnosis of ACS” as automated other potential causes of hemodynamic instability were assessed ( 14 ).…”

“…We could only identify two prior case reports describing the development of intraoperative ACS during cardiac surgery: (1) secondary ACS during failure to maintain CPB while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repairs ( 14 ). In this report, the authors reported a “relatively long period of time was needed to make a diagnosis of ACS” as automated other potential causes of hemodynamic instability were assessed ( 14 ). (2) Rabbi et al described another secondary ACS occurring during elective coronary revascularization, resulting in the inability to wean off CPB ( 10 ).…”

First Report of Fatal Secondary Abdominal Compartment Syndrome Induced by Intestinal Gas Accumulation without Organic Occlusive Intestinal Lesion in a Child with Sepsis

“…Although the IAP measurement using intravesical pressure is important for the diagnosis of ACS [8], it is not always measured for the diagnosis of ACS. Considerable increase of IAP was confirmed solely by external physical finding with percutaneous needle decompression for tension pneumoperitoneum [9] and with a decompression laparotomy [10] in previously reported ACS cases. In the present case, muscular defense by peritonitis was unlikely based on the autopsy findings, and the severely distended abdominal surface was extremely stiff despite the use of a muscle relaxant.…”

Minimally Invasive Mitral Valve Repair Through Right Minithoracotomy ― 11-Year Single Institute Experience ―

“…23 Abdominal compartment syndrome requiring emergency surgical decompression has also been reported by several groups. 24,25 We experienced 1 case of retrograde aortic dissection caused by guide-wire injury to the iliac artery. That surgery was aborted and the patient underwent an MV repair through a standard sternotomy 1 year later after conservative treatment.…”