To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery
To repair or not to repair: a case report of atrioventricular groove hematoma during mitral valve surgery
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DOI：
10.1186/s13019-018-0828-0
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发表时间：
2019-01-09
影响因子：
1.6
通讯作者：
Kawase, Yushi
中科院分区：
文献类型：
--
作者：
Nagamine, Hiroshi;Date, Yusuke;Kawase, Yushi
背景：二尖瓣手术中房室沟血肿的范围从简单的血肿到复杂的房室破裂，导致直接破裂并大出血和随后的死亡。据报道，10%至30%的患者在二尖瓣置换术后立即出现左房室沟小或中等大小的血肿。尽管房室沟血肿具有固有的不稳定性和不可预测性，但由于与额外手术修复相关的高死亡率，建议采用保守策略。然而，这种保守的策略并不能解决潜在的破裂风险，而且似乎还存在一定程度的不确定性，需要利用目前心脏外科的进展来克服。我们报告一例在双瓣膜置换术中出现房室血肿的病例。手术后出现左心室假性动脉瘤，但在六个月内自然消失。在反思我们的病例后，我们制定了一份检查表，包括麻醉师的经食管超声心动图结果，以便在保守治疗和额外手术修复方面做出合理的术中决策。我们的检查表有助于组织对损伤的病理生理学理解，并整合来自互补观点的部分发现，可用于准确评估紧张情况，并在手术团队成员之间形成共识。结论1例患者在二尖瓣手术中发生房室沟血肿，并发左室假性动脉瘤。保守的策略产生了积极的结果。我们希望我们的经验和原始的检查表对面临类似情况的外科团队有价值。
BackgroundAtrioventricular groove hematomas during mitral valve surgery range from simple hematomas to complex atrioventricular disruptions that cause frank rupture with massive bleeding and subsequent mortality. A small or moderate-sized hematoma is reported to be present in the left atrioventricular groove in 10 to 30% of all patients immediately after mitral valve replacement. Despite the fact that atrioventricular groove hematomas are inherently unstable and unpredictable, conservative strategies are recommended due to the high mortality associated with additional surgical repair. Such conservative strategies, however, would not resolve the potential risk of rupture, and there also appears to be a certain degree of uncertainty to be overcome using the current advances in cardiac surgery.Case presentationWe present a case of atrioventricular hematoma during double valve replacement which was treated with conservative management. A left ventricular pseudoaneurysm developed after surgery, but spontaneously resolved completely within six months. After reflecting on our case, we developed a check sheet, including the anesthesiologist's transesophageal echocardiography findings, for reasonable intraoperative decision-making regarding conservative management vs. additional surgical repair. Our check sheet helps organize the pathophysiological understanding of the injury and integrates partial findings from complementary viewpoints, and can be used to accurately assess intense situations and develop a common understanding among surgical team members.ConclusionsOur case involved an atrioventricular groove hematoma that occurred during mitral valve surgery and caused a left ventricular pseudoaneurysm. Conservative strategies yielded positive results. We hope our experience and original check sheet will be of value to surgical teams facing similar situations.