Right Ventricular Rupture in Redo Coronary Artery Bypass Grafting

Abstract

A 71-year-old man presented to us with recurrent chest pain, which led to cardiac catheterization. He was a strong candidate for redo coronary artery bypass grafting (CABG). CT was performed to confirm whether the heart was adherent to the sternum and chest wall. For safety reasons, cardiopulmonary bypass (CPB) was first performed via right femoral cannulation before sternotomy. After the spontaneous right ventricular (RV) rupture, HTK was used to arrest the heart. Heart repair materials were applied to repair the fissure of RV to avoid further tearing and bleeding. A compromise scheme was adopted when it was found to be difficult to identify and expose well the target artery, due to severe adhesion. This was done to avoid possible severe consequences of further dissection of the heart. Intraoperative transesophageal echocardiography (TEE) was used to evaluate the cardiac function, and intra-aortic balloon pump (IABP) support was applied in time. In consideration of the RV enlargement, which TEE revealed may have been caused by myocardial edema and cardiac insufficiency, modified ultrafiltration was performed, and a timely decision of open chest management (OCM) with delayed sternal closure (DSC) was made to maintain hemodynamic stability. The patient had no further complications and eventually recovered well, according to a 4-month follow up.