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 journalArticlepeer-review

1 Scopus citations

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 - Nov 23 2010
Externally publishedYes

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

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