RIGHT-VENTRICULAR RUPTURE - A COMPLICATION OF POSTOPERATIVE MEDIASTINITIS

Mediastinitis-related right ventricular rupture is an unusual but pote ntially life-threatening complication of cardiac operations. Between J anuary 1981 and December 1990, a total of 10,182 patients underwent he art operations for ischemic, valvular, and congenital heart disease at the Montreal Heart Institute. Forty-eight patients (0.5 %) had postop erative mediastinitis necessitating surgical exploration and sternal d ebridement. The mediastinum was left open for daily irrigation with po vidone-iodine and chest reconstruction was postponed. During treatment , seven patients (0.07%) had right ventricular rupture necessitating i mmediate surgical repair. All had ischemic heart disease before the op eration. There were five women and two men, ages ranging from 52 to 65 years (mean 58 +/- 5 years). Surgical repair consisted of autologous patch covered with omentoplasty assisted with cardiopulmonary bypass. Two patients died, one during the operation of massive hemorrhage and the other 10 days after the operation of uncontrolled sepsis. Five pat ients survived 2 to 29 months (mean 23 +/- 10 months) after right vent ricular rupture, with an overall survival of 71 %. Obesity was more fr equent in the patients with right ventricular rupture and was found to be a significant risk factor (multivariate analysis, p < 0.05, relati ve risk 3.22). Histologic examination of the right ventricle in the pa tient who died after a successful repair revealed fatty infiltration o f the right ventricular wall. This may have predisposed the patient to ward ventricular rupture. In conclusion, right ventricular rupture, an unusual event in heart surgery, is related to open sternal debridemen t. Favorable outcome of this complication depends on immediate surgica l management, autologous repair, and the use of omentoplasty.