title: Traumatic false aneurysms of the left ventricle after an attempt at video-thoracoscopic surgery.
abstract: OBJECTIVES Video-thoracoscopic surgery (VTS) has been accepted as a safe and credible technique since 1990. Lung injury is one of the main perioperative complications. Few data are available about cardiac trauma and VTS-related false aneurysm of the left ventricular (LV) wall has not yet been reported.  METHODS A 62-year old woman presented with a left thoracic empyema. Video-thoracoscopy was attempted for bacterial sampling and surgical drain of the pleura. A rapid conversion to open thoracotomy was necessary to control massive bleeding after the first thoracic port intrusion. An apical systolic murmur was found 2 weeks later during a systematic clinical examination. The patient was asymptomatic and had no personal history of cardiac disease.  RESULTS Colour Doppler imaging showed two spurious aneurysms on the LV wall without any haemopericardium. Pericardial enhancement around the left ventricle was observed on the chest computerized tomography scan with the injection of contrast. After the careful excision of the two false aneurysms, a surgical repair was strengthened with a suture under a cardiopulmonary bypass. The postoperative course was uneventful and the patient was safe at 3 years.  CONCLUSIONS This is the first report of LV traumatic false aneurysms secondary to an attempt of a video-thoracoscopic procedure. This is a rare but life-threatening complication because of the risk of spontaneous rupture. Left persistent thoracic empyemas associated with the ipsilateral mediastinum deviation carry a high risk of myocardial damage related to the trocar port intrusion.
authors.affiliation: Department of Thoracic and Cardiovacular Surgery, Pontchaillou Hospital, University of Rennes 1, Rennes, France. julienguihaire@gmail.com
authors.forename: Julien
authors.initials: J
authors.lastname: Guihaire
authors.forename: Erwan
authors.initials: E
authors.lastname: Flecher
authors.forename: Bertrand
authors.initials: B
authors.lastname: de Latour
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D018618:Echocardiography, Doppler, Color; D016724:Empyema, Pleural / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006352:Heart Ventricles / Q000293:injuries; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D013536:Suture Techniques; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents