Damage control: cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy

Timothy L Van Natta; Kalpaj R Parekh; Daniel T Dearmond; Mark D Iannettoni

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Journal article

Damage control: cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy

Timothy L Van Natta, Kalpaj R Parekh, Daniel T Dearmond and Mark D Iannettoni

Texas Heart Institute journal, Vol.37(5), pp.587-590

2010

PMCID: PMC2953238

PMID: 20978577

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Abstract

While undergoing an intrapericardial pneumonectomy for a massive right pulmonary inflammatory pseudotumor that had invaded the mediastinum, an 18-year-old woman experienced a nearly fatal iatrogenic complication. Dense scarring adjacent to the pseudotumor had drawn in the superior vena cava posterolaterally and fused the right main pulmonary artery to the right superior pulmonary vein within the pericardium. The failure of a linear stapler to secure the pulmonary vessels led to torrential hemorrhage. Attempts to control the bleeding resulted in inadvertent superior vena cava occlusion and central venous pressure elevation. Because cardiopulmonary bypass might not have been reliably established in time to avoid irreversible cerebral ischemia, we borrowed a technique from congenital heart surgery and rapidly fashioned a cavoatrial connection. The patient survived the operation without negative neurologic or cardiac sequelae, recovered fully, and had no recurrence of the pseudotumor. Herein, we describe the intraoperative decisions that were made under intense time pressure to avert catastrophe.

Adolescent

Anastomosis, Surgical

Blood Loss, Surgical - prevention & control

Cardiac Surgical Procedures

Catastrophic Illness

Central Venous Pressure

Cerebrovascular Circulation

Female

Heart Atria - surgery

Hemostasis, Surgical - adverse effects

Humans

Iatrogenic Disease

Plasma Cell Granuloma, Pulmonary - pathology

Plasma Cell Granuloma, Pulmonary - surgery

Pneumonectomy - adverse effects

Superior Vena Cava Syndrome - etiology

Superior Vena Cava Syndrome - physiopathology

Superior Vena Cava Syndrome - surgery

Surgical Stapling - adverse effects

Tomography, X-Ray Computed

Treatment Outcome

Vena Cava, Superior - injuries

Vena Cava, Superior - physiopathology

Vena Cava, Superior - surgery

Details

Title: Subtitle: Damage control: cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy
Creators: Timothy L Van Natta - Department of Cardiothoracic Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa 52245, USA. tvannatta@dhs.lacounty.gov
Kalpaj R Parekh
Daniel T Dearmond
Mark D Iannettoni
Resource Type: Journal article
Publication Details: Texas Heart Institute journal, Vol.37(5), pp.587-590
PMID: 20978577
PMCID: PMC2953238
ISSN: 0730-2347
eISSN: 1526-6702
Language: English
Date published: 2010
Academic Unit: Anatomy and Cell Biology; Cardiothoracic Surgery
Record Identifier: 9984284332802771

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