Abstract
We treated a 77-year-old patient with secondary abdominal compartment syndrome that caused failure to maintain cardiopulmonary bypass while undergoing elective minimally invasive right mini-thoracotomy mitral valve and tricuspid valve repair procedures. During the operation, a decompression laparotomy was needed to relieve elevated intraabdominal pressure that caused instability of the cardiopulmonary bypass. Due to poor oxygenation and the long cardiopulmonary bypass time, the patient required peripheral extracorporeal membrane oxygenation before recovery. We alert surgeons to this rare complication that can occur even in patients undergoing minimally invasive surgery with a right mini-thoracotomy.
Highlights
Secondary abdominal compartment syndrome (ACS) is defined as widespread organ dysfunction in the respiratory, cardiac, renal, and gastrointestinal systems resulting from an increase in intraabdominal pressure that is not associated with a primary abdominal process [1]
We report a patient who developed cardiopulmonary bypass instability due to secondary ACS that occurred during minimally invasive mini-thoracotomy mitral and tricuspid valve repair procedures, which was treated with a decompressive laparotomy
Previous reports have shown an increase in intraabdominal pressure that is dependent on the degree of hemodilution after initiation of cardiopulmonary bypass, which has a significant impact in such bypass cases with cardiac arrest on mesenteric circulation [7]
Summary
Secondary abdominal compartment syndrome (ACS) is defined as widespread organ dysfunction in the respiratory, cardiac, renal, and gastrointestinal systems resulting from an increase in intraabdominal pressure that is not associated with a primary abdominal process [1]. ACS frequently occurs after an operation for abdominal trauma or ruptured abdominal aortic aneurysm and is associated with high mortality. This complication may develop in patients who have not had an abdominal injury or operation, which is referred to as secondary ACS [2]. We report a patient who developed cardiopulmonary bypass instability due to secondary ACS that occurred during minimally invasive mini-thoracotomy mitral and tricuspid valve repair procedures, which was treated with a decompressive laparotomy. Since high intraabdominal pressure was externally apparent, we decided to perform a decompression laparotomy, which was done by the general surgery team. As soon as the abdominal cavity was decompressed, central venous pressure dropped down from 15 to 4 mmHg, and the patient.
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