Conservative Management of Compressive Hematoma over Right Atrium Postoperative of Cardiac Surgery

Ricardo Levin, Marcela Degrange, Jorge Balaguer


Compression over right chambers in the early postoperative course after cardiac surgery in a fully or partially stable patient poses a challenge as to what approach to follow, especially regarding the best management of the situation.

This report describes the case of a 54-year-old male patient with a significant clinical history –including previous coronary artery bypass surgery–, who underwent mitral and aortic valve replacement (with bioprostheses), and tricuspid valve repair. Due to massive bleeding unresponsive to transfusion of blood products during surgery, the patient was re-explored in the operating room; a recombinant activated factor VII dose was infused as a result of diffuse bleeding. During postoperative course, the patient presented with high atrium pressure, in which an isolated compression due to hematoma was detected; initially a conservative approach was adopted. The patient was monitored under continuous transesophageal echocardiogram, and management was based on ventricular filling parameters, in addition to direct and continuous observation of the hematoma.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020