title: Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.
abstract: We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Ohira
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
authors.affiliation: Department of Cardiovascular Surgery, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan Department of Cardiology, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Cardiovascular Surgery, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan Department of Cardiology, Sakurakai Takahashi Hospital, Kobe, Hyogo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000209:etiology* / Q000601:surgery*