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Ann Thorac Surg 1990;49:810-813
© 1990 The Society of Thoracic Surgeons

Articles

Management of extensive right ventricular injury or rupture

A.David Slater, MD*, John P. Gott, MD, Gordon R. Tobin, II, MD, Laman A. Gray, Jr, MD

Department of Surgery, University of Louisville School of Medicine, and the Jewish Hospital Heart and Lung Institute, Louisville, Kentucky, USA

Accepted for publication January 15, 1990.

* Address reprint requests to Dr Slater, Department of Surgery, University of Louisville, 550 South Jackson St, Louisville, KY 40292.

Most penetrating right ventricular injuries require simple suture repair, but more extensive injury or rupture of the right ventricle may not be amenable to this method. We have developed an approach to the problem and a technique for repair. Compression of the area with early institution of cardiopulmonary bypass will result in decompression of the right ventricle and preservation of perfusion, preventing profound hypotension. Coverage with an onlay autologous tissue patch provides hemostatic control of the defect without compromising ventricular function. Reinforcement with omentum or muscle flap can give additional protection when risk of infection is present. Application of these principles can be lifesaving and insure good cardiac function despite massive injury to the right ventricular myocardium.




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