Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

Susumu Isoda^1*, Tamizo Kimura², Katsunori Tanaka², Kenji Nishimura², Nozomu Yamanaka², Shin-ichi Taguchi², Keiji Uchida¹, Norihisa Karube¹, Kiyotaka Imoto¹

¹Department of Cardiovascular Surgery, Yokohama City University Medical Center, Yokohama, Japan.
²Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan.

DOI: 10.4236/ojts.2015.51003                

Abstract

A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb; CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica; Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

Keywords

Blowout, Cardiac Rupture, Sutureless Repair, Aortic Dissection, TachoComb

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Purcaro, A., Costantini, C., Ciampani, N., Mazzanti, M., Silenzi, C., Gili, A., et al. (1997) Diagnostic Criteria and Management of Subacute Ventricular Free Wall Rupture Complicating Acute Myocardial Infarction. The American Journal of Cardiology, 80, 397-405. http://dx.doi.org/10.1016/S0002-9149(97)00385-8
[2]	McMullan, M.H., Maples, M.D., Kilgore Jr., T.L. and Hindman, S.H. (2001) Surgical Experience with Left Ventricular Free Wall Rupture. The Annals of Thoracic Surgery, 71, 1894-1899. http://dx.doi.org/10.1016/S0003-4975(01)02625-X
[3]	Tobara, T. (2004) Salvaged Cases of Blow-Out Type Cardiac Rupture Complicating Acute Myocardial Infarction. The Japanese Journal of Intensive Care Medicine, 28, 719-722. (In Japanese)
[4]	Padro, J.M., Mesa, J.M., Silvestre, J., Larrea, J.L., Caralps, J.M., Cerron, F. and Aris, A. (1993) Subacute Cardiac Rupture: Repair with a Sutureless Technique. The Annals of Thoracic Surgery, 55, 20-24. http://dx.doi.org/10.1016/0003-4975(93)90468-W
[5]	Lachapelle, K., deVarennes, B., Ergina, P.L. and Cecere, R. (2002) Sutureless Patch Technique for Postinfarction Left Ventricular Rupture. The Annals of Thoracic Surgery, 74, 96-101. http://dx.doi.org/10.1016/S0003-4975(02)03581-6
[6]	Canovas, S.J., Lim, E., Dalmau, M.J., Bueno, M., Buendia, J., Hornerero, F., et al. (2003) Midterm Clinical and Echocardiographic Results with Patch Glue Repair of Left Ventricular Free Wall Rupture. Circulation, 108, II-237-II-240. http://dx.doi.org/10.1161/01.cir.0000089042.80722.7a
[7]	Iha, K., Ikemura, R., Higa, N., Akasaki, M., Kuniyoshi, Y. and Koja, K. (2001) Left Ventricular Pseudoaneurysm after Sutureless Repair of Subacute Left Ventricular Free Wall Rupture: A Case Report. Annals of Thoracic and Cardiovascular Surgery, 7, 311-314.
[8]	Isoda, S., Kimura, T., Mashiko, Y., Nakamura, S. and Maehara, T. (2011) In Vitro Study of the Optimum Volume Ratio of Activator to Adhesive in Gelatin-Resorcin-Formalin Glue. General Thoracic and Cardiovascular Surgery, 59, 326-328. http://dx.doi.org/10.1007/s11748-009-0552-8
[9]	Moreno, R., Lopez, E., Lopez-Sendon, J.L., Garcia, E., Sariano, J., Abeytua, M., et al. (2000) Frequency of Left Ventricular Free-Wall Rupture in Patient with Acute Myocardial Infarction Treated with Primary Angioplasty. The American Journal of Cardiology, 85, 757-760. http://dx.doi.org/10.1016/S0002-9149(99)00855-3
[10]	Figueras, J., Alcalde, O., Barrabés, J.A., Serra, V., Alguersuari, J., Cortadellas, J. and Lidon, R.M. (2008) Changes in Hospital Mortality Rates in 425 Patients with Acute ST-Elevation Myocardial Infarction and Cardiac Rupture over a 30-Year Period. Circulation, 118, 2783-2789. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.776690
[11]	Kirklin, J.W. (2003) Left Ventricular Aneurysm. In: Kirklin, J.W. and Barrat-Boyes, B.G., Eds., Cardiac Surgery, 3rd Edition, Churchill Livingstone, London, 437-455.
[12]	Nishizaki, K., Seki, T., Fujii, A., Nishida, Y. and Funabiki, M. (2004) Sutureless Patch Repair for Small Blowout Rupture of the Left Ventricle after Myocardial Infarction. The Japanese Journal of Thoracic and Cardiovascular Surgery, 52, 268-271. http://dx.doi.org/10.1007/s11748-004-0123-y
[13]	Amano, H., Ohara, K., Nie, M., Torii, S., Miyoshi, Y. and Yoshimura, H. (2002) New Surgical Technique of Left Ventricular Free Wall Rupture: Double Patch Sealing Method. Annals of Thoracic and Cardiovascular Surgery, 8, 389-392.