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Letters to the Editor

Spontaneous right ventricular rupture in re-operative cardiac surgery

Department of Cardiac Surgery, University Hospital, Jeddah 80215, Saudi Arabia

Received 21 April 2009; accepted 4 June 2009.

^_* Corresponding author. Tel.: +966 26401000; fax: +966 26952088. (Email: dr.k-e{at}hotmail.com).

Key Words: Spontaneous • Right ventricle • Rupture

I read with interest the article ‘Spontaneous right ventricular rupture after sternal dehiscence following coronary artery bypass grafting’ by Elsayed and colleagues in Images in Cardiothoracic Surgery [1]. I believe that the rupture was an induced perforation of the right ventricle, rather than it being spontaneous. It caused a steady, slow bleeding forming substernal and pleural collections and not exsanguination of right ventricular (RV) rupture. This reminded me of an actual spontaneous RV rupture that occurred within a few seconds of successful completion of a sternal split in a re-operation for the mitral valve in an elderly woman. The right ventricle was intact upon entry, and it started to tear apart without spreading the sternal edges, thus causing exsanguination and shock. Immediate mobilisation of the sternum, control of the bleeding by Foley's catheter and rapid institution of femoro-femoral cardiopulmonary bypass helped in stabilising the patient, who eventually recovered well. A retrospective analysis of the case and echocardiography revealed extreme thinning of the right ventricle and dilatation caused by long-standing pulmonary hypertension. The case presented by Elsayed emphasises the concept of a proper sternal closure, especially in the elderly, following a coronary bypass where some patients may need reinforced sternal closure to avoid some of the dreadful, preventable complications of cardiac surgery caused by the sternal wound [2,3].

References

1. Elsayed H, Bashir M, Thelogou T, Mediratta N. Spontaneous right ventricular rupture after sternal dehiscence following coronary artery bypass grafting. Eur J Cardiothorac Surg 2009;35:730.[Free Full Text]
2. Schimmer C, Sommer S-P, Bensch M, Bohrer T, Aleksic I, Leyh R. Sternal closure techniques and postoperative sternal wound complications in elderly patients. Eur J Cardiothorac Surg 2008;34:132-138.[Abstract/Free Full Text]
3. Al Ebrahim K. Reinforced sternal closure: the bilateral straight longitudinal wire technique. Asian Cardiovasc Thorac Ann 2003;11:90-91.[Abstract/Free Full Text]

This article has been cited by other articles:

				H. Elsayed, M. Bashir, T. Thelogou, and N. Mediratta Reply to Al-Ebrahim Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 605 - 605. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Google Scholar Articles by Al-Ebrahim, K. E. PubMed Articles by Al-Ebrahim, K. E. Related Collections Chest wall