초록접수 현황
| 17F-209 | 포스터 발표 |
Temporary Control of Right Atrial Rupture after Blunt Chest Trauma using Polyglycolic Acid Sheet with Fibrin Glue (TachoComb)
Se Min Ryu, Sung-Min Park, Kyung-Hak Lee, Seong-Joon Cho, Se-Ran Yang, Jeong-Ran Park, Ki Hwan Kim, Jung Eui Yun, Jin Soo Lee
Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Gangwon-do, Republic of Korea
Purpose : Traumatic cardiac rupture is a very uncommon entity and has a very high mortality rate of 80%.
Methods : A 46-year old male patient was transferred to our hospital because of car accident. Chest CT showed multiple ribs and sternal fracture, lung contusion, hemothorax, hemopericardium, and pneumomediastinum (Figure A). His hemodynamic condition was worsening gradually, with a systolic blood pressure of 60 mmHg. A Transthoracic echocardiography revealed cardiac tamponade. The patient was immediately taken to the operating room for exploration of cardiac injury.
Results : Median sternotomy was performed with pump standby. A sudden catastrophic hemorrhage occurred from the right atrial rupture site immediately after the pericardium was opened. One assistant performed direct open cardiac massage for about 3 minutes. We found that Right atrium – IVC junction site rupture, which was 5cm length and ran parallel to the right coronary artery. Direct manual compression for bleeding control of rupture site was not effective due to right atrial decompression associated with manual pressure resulted in aggravation of hemodynamic instability. We decided to use of polyglycolic acid sheet with fibrin glue : TachoComb (Torii Pharmaceutical, Tokyo, Japan) which was positioned on the RA rupture area. Active bleeding was stopped and then cardiopulmonary bypass was established. Under direct visualization, we removed Tachocomb patch and rupture site was repaired with 4-0 polypropylene sutures (Figure B). The postoperative course was uneventful.
Conclusion : This experience suggests that the TachoComb patch is effective for temporary right atrial rupture control, especially which is located on inferior or posterior site of heart.
Methods : A 46-year old male patient was transferred to our hospital because of car accident. Chest CT showed multiple ribs and sternal fracture, lung contusion, hemothorax, hemopericardium, and pneumomediastinum (Figure A). His hemodynamic condition was worsening gradually, with a systolic blood pressure of 60 mmHg. A Transthoracic echocardiography revealed cardiac tamponade. The patient was immediately taken to the operating room for exploration of cardiac injury.
Results : Median sternotomy was performed with pump standby. A sudden catastrophic hemorrhage occurred from the right atrial rupture site immediately after the pericardium was opened. One assistant performed direct open cardiac massage for about 3 minutes. We found that Right atrium – IVC junction site rupture, which was 5cm length and ran parallel to the right coronary artery. Direct manual compression for bleeding control of rupture site was not effective due to right atrial decompression associated with manual pressure resulted in aggravation of hemodynamic instability. We decided to use of polyglycolic acid sheet with fibrin glue : TachoComb (Torii Pharmaceutical, Tokyo, Japan) which was positioned on the RA rupture area. Active bleeding was stopped and then cardiopulmonary bypass was established. Under direct visualization, we removed Tachocomb patch and rupture site was repaired with 4-0 polypropylene sutures (Figure B). The postoperative course was uneventful.
Conclusion : This experience suggests that the TachoComb patch is effective for temporary right atrial rupture control, especially which is located on inferior or posterior site of heart.
책임저자: Se Min Ryu
Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Gangwon-do, Republic of Korea
발표자: Se Min Ryu, E-mail : semin@kangwon.ac.kr