Spinal-Epidural Hematoma Presenting as Paraplegia Following Mitral Valve Surgery: A Case Report

Karlekar, Anil; Dutta, Devesh; Arora, Kapil; Mishra, Yugal

doi:10.1053/j.jvca.2013.07.012

Cited by 6 publications

(3 citation statements)

References 9 publications

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“… 6 There is a paucity of literature for the risk of clinically significant progression of a previously identified traumatic epidural hematoma after systemic heparinization, though there are reports of clinically significant spontaneous SEH after CPB for MV surgery. 7 Given risk of spontaneous hematoma development during CPB, progression of an existing SEH should be considered in the decision to anticoagulate.…”

Section: Discussionmentioning

confidence: 99%

High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma

Paisley

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Thomas

2018

THORAC CARDIOV SURG Reports

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IntroductionCardiac valvular injury after blunt trauma is an unusual etiology of shock and merits a high index of suspicion for diagnosis. The majority of mitral valve (MV) injuries involve the papillary muscles or chordae tendinae with repair tailored at the underlying pathology. Few reports of MV injury in the setting of trauma exist with the largest review totaling 82 cases in a 2009 publication.1 We report a case of cardiogenic shock due to MV insufficiency in setting of polytrauma. Case DescriptionA 56-year-old woman with a history of depression presented after a fall of 30 m, reportedly landing upon bushes cushioning her impact. Admission blood pressure was 88/48 mm Hg and pulse was 110 bpm. Physical examination and chest radiograph were unremarkable for any significant signs of trauma. Cross-sectional imaging revealed multiple rib fractures, right pneumothorax, splenic, renal and liver lacerations, cervical and thoracic spine fractures, an ulnar fracture, and a spinal epidural hematoma (SEH). Her calculated injury severity score was 29 and trauma score-injury severity score predicting 24.4% likelihood of death. AbstractBackground The rare complication of mitral valve rupture from blunt trauma is certainly not at the top of the differential of shock. Case Description We report the case of a 56-year-old woman who sustained numerous injuries after a 30-m fall with cardiogenic shock secondary to mitral valve rupture causing severe mitral valve regurgitation. Management included successful primary leaflet repair, annuloplasty, and single vessel coronary artery bypass. Conclusion Valvular repair in the setting of polytrauma is a complex decision that requires careful balance of risks and benefits relative to patient stability.

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Section: Discussionmentioning

confidence: 99%

High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma

Paisley

DeBoard

Thomas

2018

THORAC CARDIOV SURG Reports

View full text Add to dashboard Cite

show abstract

“…6 There is a paucity of literature for the risk of clinically significant progression of a previously identified traumatic epidural hematoma after systemic heparinization, though there are reports of clinically significant spontaneous SEH after CPB for MV surgery. 7 Given risk of spontaneous hematoma development during CPB, progression of an existing SEH should be considered in the decision to anticoagulate.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2018

THORAC CARDIOV SURG Reports

View full text Add to dashboard Cite

IntroductionCardiac valvular injury after blunt trauma is an unusual etiology of shock and merits a high index of suspicion for diagnosis. The majority of mitral valve (MV) injuries involve the papillary muscles or chordae tendinae with repair tailored at the underlying pathology. Few reports of MV injury in the setting of trauma exist with the largest review totaling 82 cases in a 2009 publication. 1 We report a case of cardiogenic shock due to MV insufficiency in setting of polytrauma. Case DescriptionA 56-year-old woman with a history of depression presented after a fall of 30 m, reportedly landing upon bushes cushioning her impact. Admission blood pressure was 88/48 mm Hg and pulse was 110 bpm. Physical examination and chest radiograph were unremarkable for any significant signs of trauma. Cross-sectional imaging revealed multiple rib fractures, right pneumothorax, splenic, renal and liver lacerations, cervical and thoracic spine fractures, an ulnar fracture, and a spinal epidural hematoma (SEH). Her calculated injury severity score was 29 and trauma score-injury severity score predicting 24.4% likelihood of death. AbstractBackground The rare complication of mitral valve rupture from blunt trauma is certainly not at the top of the differential of shock. Case Description We report the case of a 56-year-old woman who sustained numerous injuries after a 30-m fall with cardiogenic shock secondary to mitral valve rupture causing severe mitral valve regurgitation. Management included successful primary leaflet repair, annuloplasty, and single vessel coronary artery bypass. Conclusion Valvular repair in the setting of polytrauma is a complex decision that requires careful balance of risks and benefits relative to patient stability.

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“…Cases of epidural hematoma have been reported, though they are rare, [6][7][8] and despite publication of several large case series without any reported neurological complications [9][10][11][12] epidural analgesia in heart surgery remains controversial. This is largely because of an unclear risk and a continued fear of neurological complications.…”

Section: Epidural Hematomamentioning

confidence: 99%

High Thoracic Epidural in Cardiac Anesthesia

Jakobsen

2014

Semin Cardiothorac Vasc Anesth

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High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the epidural catheter has become increasingly difficult. The greatest limitation to its use might be the believed increased risk of epidural hematoma associated with anticoagulation during cardiopulmonary bypass. The aim of this review is to give an overview of complications and effect on outcomes with focus on cardiac performance and postoperative glycemic control and kidney function. Patients with epidurals may have improved postoperative pulmonary function and shorter ventilation time, while impact on length of stay in the intensive care unit and hospital is not as evident. HTEA is effective in pain management, attenuates perioperative stress and seems to improve postoperative blood glucose control. Whether HTEA improves recovery and facilitates fast-track is still to be confirmed. With regard to serious postoperative complications, there is evidence of reduction in supraventricular arrhythmias and lower frequency of postoperative acute kidney injury and dialysis. There are some indications of lower short term mortality and frequency of postoperative myocardial infarctions, but only as a combined outcome. The present short-term mortality of 1% to 2% should be compared with the most pessimistic frequency of epidural hematoma being 1 in 4600 patients.

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Spinal-Epidural Hematoma Presenting as Paraplegia Following Mitral Valve Surgery: A Case Report

Cited by 6 publications

References 9 publications

High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma

High-Risk Repair of Traumatic Mitral Valve Rupture in the Setting of Polytrauma

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High Thoracic Epidural in Cardiac Anesthesia

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