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Isolated central venous pressure elevation caused by hematoma formation compressing the superior vena cava following a Bentall operation: a case report.

Song Y, Sim J, Seo SJ, Choi SA, Shim JK - Korean J Anesthesiol (2014)

Bottom Line: We present a case of a patient exhibiting isolated elevation of the central venous pressure with minimal hemodynamic deterioration in an immediate postoperative period after Bentall operation requiring re-exploration.However, even in the absence of significant hemodynamic deterioration, the development of loculated hematoma that compresses the superior vena cava should be ruled out, as it can be life-threatening through the formation of cerebral and laryngeal edema, similar to superior vena cava syndrome.This case emphasizes the importance of a prompt differential diagnosis of the isolated central venous pressure elevation after cardiac surgery with transesophageal echocardiography for the administration of appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
We present a case of a patient exhibiting isolated elevation of the central venous pressure with minimal hemodynamic deterioration in an immediate postoperative period after Bentall operation requiring re-exploration. Isolated elevation of the central venous pressure usually alerts physicians of a volume overload or right ventricular dysfunction. However, even in the absence of significant hemodynamic deterioration, the development of loculated hematoma that compresses the superior vena cava should be ruled out, as it can be life-threatening through the formation of cerebral and laryngeal edema, similar to superior vena cava syndrome. This case emphasizes the importance of a prompt differential diagnosis of the isolated central venous pressure elevation after cardiac surgery with transesophageal echocardiography for the administration of appropriate treatment.

No MeSH data available.


Related in: MedlinePlus

Transesophageal echocardiographic, midesophageal aortic valve long axis view showing the hematoma in the transverse sinus, a potential space. LA: left atrium.
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Figure 2: Transesophageal echocardiographic, midesophageal aortic valve long axis view showing the hematoma in the transverse sinus, a potential space. LA: left atrium.

Mentions: A TEE examination was immediately performed to confirm the cause of the CVP elevation, which revealed minimal pericardial fluid collection and preserved biventricular function in the midesophageal four-chamber view and the transgastric short axis view. The midesophageal bicaval view showed the right atrium (RA) being pushed anteriorly and laterally by a large mass measuring 6.06 cm × 8.78 cm (Fig. 1). The mass contained echogenic materials with some echo-free areas, which is consistent with hematoma, and as a result the SVC was almost completely obliterated by it. In the midesophageal aortic valve long axis view, the hematoma occupied the transverse sinus as well (Fig. 2). The patient was immediately transferred to the operating room for re-exploration. A loculated hematoma around the valved graft was found to compress the entire SVC and extended to the RA. After evacuation of the hematoma, the CVP decreased immediately from 23 to 11 mmHg. The cardiac index and the blood pressure remained stable despite the discontinuation of the vasopressor and inotropic agents. However, the patient's postoperative course deteriorated, with the development of acute renal failure and adult respiratory distress syndrome, which resulted in the prolongation of ICU stay. The patient was then transferred to the general ward at postoperative day (POD) 52 for rehabilitation, and discharged at POD 109.


Isolated central venous pressure elevation caused by hematoma formation compressing the superior vena cava following a Bentall operation: a case report.

Song Y, Sim J, Seo SJ, Choi SA, Shim JK - Korean J Anesthesiol (2014)

Transesophageal echocardiographic, midesophageal aortic valve long axis view showing the hematoma in the transverse sinus, a potential space. LA: left atrium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927006&req=5

Figure 2: Transesophageal echocardiographic, midesophageal aortic valve long axis view showing the hematoma in the transverse sinus, a potential space. LA: left atrium.
Mentions: A TEE examination was immediately performed to confirm the cause of the CVP elevation, which revealed minimal pericardial fluid collection and preserved biventricular function in the midesophageal four-chamber view and the transgastric short axis view. The midesophageal bicaval view showed the right atrium (RA) being pushed anteriorly and laterally by a large mass measuring 6.06 cm × 8.78 cm (Fig. 1). The mass contained echogenic materials with some echo-free areas, which is consistent with hematoma, and as a result the SVC was almost completely obliterated by it. In the midesophageal aortic valve long axis view, the hematoma occupied the transverse sinus as well (Fig. 2). The patient was immediately transferred to the operating room for re-exploration. A loculated hematoma around the valved graft was found to compress the entire SVC and extended to the RA. After evacuation of the hematoma, the CVP decreased immediately from 23 to 11 mmHg. The cardiac index and the blood pressure remained stable despite the discontinuation of the vasopressor and inotropic agents. However, the patient's postoperative course deteriorated, with the development of acute renal failure and adult respiratory distress syndrome, which resulted in the prolongation of ICU stay. The patient was then transferred to the general ward at postoperative day (POD) 52 for rehabilitation, and discharged at POD 109.

Bottom Line: We present a case of a patient exhibiting isolated elevation of the central venous pressure with minimal hemodynamic deterioration in an immediate postoperative period after Bentall operation requiring re-exploration.However, even in the absence of significant hemodynamic deterioration, the development of loculated hematoma that compresses the superior vena cava should be ruled out, as it can be life-threatening through the formation of cerebral and laryngeal edema, similar to superior vena cava syndrome.This case emphasizes the importance of a prompt differential diagnosis of the isolated central venous pressure elevation after cardiac surgery with transesophageal echocardiography for the administration of appropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
We present a case of a patient exhibiting isolated elevation of the central venous pressure with minimal hemodynamic deterioration in an immediate postoperative period after Bentall operation requiring re-exploration. Isolated elevation of the central venous pressure usually alerts physicians of a volume overload or right ventricular dysfunction. However, even in the absence of significant hemodynamic deterioration, the development of loculated hematoma that compresses the superior vena cava should be ruled out, as it can be life-threatening through the formation of cerebral and laryngeal edema, similar to superior vena cava syndrome. This case emphasizes the importance of a prompt differential diagnosis of the isolated central venous pressure elevation after cardiac surgery with transesophageal echocardiography for the administration of appropriate treatment.

No MeSH data available.


Related in: MedlinePlus