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

pp 484-487

Abstract

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 trans-
fusion 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.