Damage control: Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)587-590
Number of pages4
JournalTexas Heart Institute Journal
Volume37
Issue number5
StatePublished - 2010
Externally publishedYes

Fingerprint

Superior Vena Cava
Pneumonectomy
Pulmonary Plasma Cell Granuloma
Hemorrhage
Central Venous Pressure
Pulmonary Veins
Pericardium
Mediastinum
Brain Ischemia
Cardiopulmonary Bypass
Nervous System
Pulmonary Artery
Thoracic Surgery
Cicatrix
Recurrence
Lung

Keywords

  • Catastrophic illness
  • Cerebrovascular circulation
  • Iatrogenic disease
  • Intraoperative period
  • Lung neoplasms/surgery
  • Pneumonectomy/adverse effects
  • Pulmonary artery/pathology
  • Time factors
  • Treatment outcome
  • Vena cava, superior/surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Van Natta, T. L., Parekh, K. R., Dearmond, D. T., & Iannettoni, M. D. (2010). Damage control: Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy. Texas Heart Institute Journal, 37(5), 587-590.

Damage control : Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy. / Van Natta, Timothy L.; Parekh, Kalpaj R.; Dearmond, Daniel T; Iannettoni, Mark D.

In: Texas Heart Institute Journal, Vol. 37, No. 5, 2010, p. 587-590.

Research output: Contribution to journalArticle

Van Natta, TL, Parekh, KR, Dearmond, DT & Iannettoni, MD 2010, 'Damage control: Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy', Texas Heart Institute Journal, vol. 37, no. 5, pp. 587-590.
Van Natta, Timothy L. ; Parekh, Kalpaj R. ; Dearmond, Daniel T ; Iannettoni, Mark D. / Damage control : Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy. In: Texas Heart Institute Journal. 2010 ; Vol. 37, No. 5. pp. 587-590.
@article{1a3645df5669451bb6b7d2a08ae6e0a2,
title = "Damage control: Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy",
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.",
keywords = "Catastrophic illness, Cerebrovascular circulation, Iatrogenic disease, Intraoperative period, Lung neoplasms/surgery, Pneumonectomy/adverse effects, Pulmonary artery/pathology, Time factors, Treatment outcome, Vena cava, superior/surgery",
author = "{Van Natta}, {Timothy L.} and Parekh, {Kalpaj R.} and Dearmond, {Daniel T} and Iannettoni, {Mark D.}",
year = "2010",
language = "English (US)",
volume = "37",
pages = "587--590",
journal = "Texas Heart Institute Journal",
issn = "0730-2347",
publisher = "Texas Heart Institute",
number = "5",

}

TY - JOUR

T1 - Damage control

T2 - Cavoatrial anastomosis during a catastrophic right intrapericardial pneumonectomy

AU - Van Natta, Timothy L.

AU - Parekh, Kalpaj R.

AU - Dearmond, Daniel T

AU - Iannettoni, Mark D.

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

KW - Catastrophic illness

KW - Cerebrovascular circulation

KW - Iatrogenic disease

KW - Intraoperative period

KW - Lung neoplasms/surgery

KW - Pneumonectomy/adverse effects

KW - Pulmonary artery/pathology

KW - Time factors

KW - Treatment outcome

KW - Vena cava, superior/surgery

UR - http://www.scopus.com/inward/record.url?scp=78449255038&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78449255038&partnerID=8YFLogxK

M3 - Article

C2 - 20978577

AN - SCOPUS:78449255038

VL - 37

SP - 587

EP - 590

JO - Texas Heart Institute Journal

JF - Texas Heart Institute Journal

SN - 0730-2347

IS - 5

ER -