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Chest drain injury of the heart


Authors: I. Hanke 1;  T. Suchý 2;  M. Lopourová 1;  J. Vojáček 1
Authors place of work: Kardiochirurgická klinika FN Hradec Králové přednosta: prof. MUDr. J. Harrer, CSc 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny FN Hradec Králové přednosta: MUDr. T. Suchý 2
Published in the journal: Rozhl. Chir., 2017, roč. 96, č. 11, s. 475-477.
Category: Case Report

Summary

Introduction:
Injury to the heart during chest drainage is a very rare but potentially fatal complication of the procedure.

Case report:
A 56-year-old, polymorbid, poorly co-operative and extremely obese patient with chronic cardiac subcompensation and pleural effusion was admitted to a district hospital. A drain was inserted into the left pleural cavity in order to evacuate the pleural effusion. Fresh oxygenated blood was flowing out from the drain. The drain was clamped immediately.

Echocardiography showed drain insertion into the left ventricle. A cardiac surgeon was contacted and indicated patient transfer to a cardiac surgery department followed by an emergency surgery. During the surgery performed through a left thoracotomy, a defect in the left ventricular wall was sutured. The patient was then stabilized, transferred back to the district hospital and, after achieving cardiopulmonary compensation, discharged home.

Conclusion:
Injury to the heart in chest drainage is a very serious iatrogenic complication. If it is to be managed successfully, the site of the insertion of the drain tip needs to be correctly identified and the drain must not be extracted. A surgical department capable of adequately addressing this complication needs to be contacted promptly, as emergency surgery may be the only lifesaving possibility.

Key words:
chest drainage – complication – heart injury


Zdroje

1. Vodička J, Doležal J, Vejvodová S, et l. Poranění hrudníku a jeho operační léčba u polytraumatizovaných nemocných v pětiletém období. Acta Chir OrthopTraum cech 2016;83:123–6.

2. Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: A comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014;4:143–55.

3. Haron H, Rashid NA, Dimon MZ, et al. Chest tube injury to left ventricle: complication or negligence? Ann Thorac Surg 2010;90:308–9.

4. Abad C, Padron A. Accidental perforation of the left ventricle with a chest drain tube. Tex Heart Inst J 2002;29:143.

5. Asopa S, Iyenger S, Lloyd CT, et al. Accidental perforation of the left ventricle with a Bonanno catheter. J Thorac Cardiovas Surg 2009;137:1023–4.

6. Kerger H, Blaettner T, Froehlich C, et al, Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life-threatening complication. Resuscitation 2007;74:178–82.

Štítky
Surgery Orthopaedics Trauma surgery
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