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Fracture of first rib after sternotomy.

Arora D, Mehta Y - Indian J Anaesth (2011)

View Article: PubMed Central - PubMed

Affiliation: Institute of Anaesthesiology and Critical Care, Medanta-The Medicity, Gurgaon, India.

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The symptoms depend upon the location of the fracture and associated brachial plexus injury... Echocardiography showed global hypokinesia of the left ventricle with ejection fraction of 30% and moderate to severe mitral regurgitation with predicted pulmonary artery pressure (PAP) of 50 mmHg... Total cardiopulmonary bypass (CPB) and aortic cross clamp time was 161 and 108 min respectively... Total surgical time was 350 min... Sternal retraction was done with double-blade retractor... Intraoperative period was uneventful... During the postoperative period, the patient was haemodynamically stable with minimal inotropic support... Patient was electively ventilated for 16 h postoperatively in view of high PAP and combined surgical procedure... Patient did not have pain, numbness or parasthesia in the left upper limb... There was no evidence suggestive of associated brachial plexus injury... Rib fracture is common after sternotomy and often goes unnoticed... Occult rib fractures are often a major cause of non-incisional chest pain in patients who have undergone sternotomy.

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Postoperative chest radiograph showing fracture of left first rib
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Figure 0002: Postoperative chest radiograph showing fracture of left first rib

Mentions: A 71-year-old gentleman with coronary artery and ischemic mitral regurgitation presented for coronary artery bypass grafting (CABG) and mitral valve repair. He was suffering from hypertension and chronic renal disease. His preoperative investigations revealed serum creatinine of 1.8 mg/dl and blood urea of 109 mg/dl. The rest of the investigations were within normal limits. Chest radiograph revealed cardiomegaly and congested lung fields [Figure 1]. Echocardiography showed global hypokinesia of the left ventricle with ejection fraction of 30% and moderate to severe mitral regurgitation with predicted pulmonary artery pressure (PAP) of 50 mmHg. He underwent CABG with three saphenous vein grafts and mitral valve repair with Carpentier Edwards classic ring. Total cardiopulmonary bypass (CPB) and aortic cross clamp time was 161 and 108 min respectively. Total surgical time was 350 min. Sternal retraction was done with double-blade retractor. Intraoperative period was uneventful. During the postoperative period, the patient was haemodynamically stable with minimal inotropic support. Postoperative portable chest radiograph revealed fracture of the left first rib [Figure 2]. Patient was electively ventilated for 16 h postoperatively in view of high PAP and combined surgical procedure. Patient did not have pain, numbness or parasthesia in the left upper limb. There was no evidence suggestive of associated brachial plexus injury.


Fracture of first rib after sternotomy.

Arora D, Mehta Y - Indian J Anaesth (2011)

Postoperative chest radiograph showing fracture of left first rib
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106410&req=5

Figure 0002: Postoperative chest radiograph showing fracture of left first rib
Mentions: A 71-year-old gentleman with coronary artery and ischemic mitral regurgitation presented for coronary artery bypass grafting (CABG) and mitral valve repair. He was suffering from hypertension and chronic renal disease. His preoperative investigations revealed serum creatinine of 1.8 mg/dl and blood urea of 109 mg/dl. The rest of the investigations were within normal limits. Chest radiograph revealed cardiomegaly and congested lung fields [Figure 1]. Echocardiography showed global hypokinesia of the left ventricle with ejection fraction of 30% and moderate to severe mitral regurgitation with predicted pulmonary artery pressure (PAP) of 50 mmHg. He underwent CABG with three saphenous vein grafts and mitral valve repair with Carpentier Edwards classic ring. Total cardiopulmonary bypass (CPB) and aortic cross clamp time was 161 and 108 min respectively. Total surgical time was 350 min. Sternal retraction was done with double-blade retractor. Intraoperative period was uneventful. During the postoperative period, the patient was haemodynamically stable with minimal inotropic support. Postoperative portable chest radiograph revealed fracture of the left first rib [Figure 2]. Patient was electively ventilated for 16 h postoperatively in view of high PAP and combined surgical procedure. Patient did not have pain, numbness or parasthesia in the left upper limb. There was no evidence suggestive of associated brachial plexus injury.

View Article: PubMed Central - PubMed

Affiliation: Institute of Anaesthesiology and Critical Care, Medanta-The Medicity, Gurgaon, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The symptoms depend upon the location of the fracture and associated brachial plexus injury... Echocardiography showed global hypokinesia of the left ventricle with ejection fraction of 30% and moderate to severe mitral regurgitation with predicted pulmonary artery pressure (PAP) of 50 mmHg... Total cardiopulmonary bypass (CPB) and aortic cross clamp time was 161 and 108 min respectively... Total surgical time was 350 min... Sternal retraction was done with double-blade retractor... Intraoperative period was uneventful... During the postoperative period, the patient was haemodynamically stable with minimal inotropic support... Patient was electively ventilated for 16 h postoperatively in view of high PAP and combined surgical procedure... Patient did not have pain, numbness or parasthesia in the left upper limb... There was no evidence suggestive of associated brachial plexus injury... Rib fracture is common after sternotomy and often goes unnoticed... Occult rib fractures are often a major cause of non-incisional chest pain in patients who have undergone sternotomy.

No MeSH data available.


Related in: MedlinePlus