Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?

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Abstract
Mediastinitis and/or sternal dehiscence developed in 143 out of 10,263patients (1.4%) who underwent cardiac surgery between January 1979-December 1993. Mediastinal drainage, sternal debridement and early woundclosure with pectoralis major and/or rectus abdominalis muscle flaps wasthe treatment employed. Between these two stages of treatment, massivehemorrhage developed in seven patients (0.07%) from a tear of the anteriorwall of the right ventricle (RV). Six patients survived. Temporary controlof the bleeding was achieved with digital or full palm pressure control ofthe ventricular tear. This was followed by immediate repair in theoperating room (OR). The only death was due to exsanguination in theintensive care unit. The other six patients were taken to the OR. Theanterior RV was freed from the underside of the sternum and the RV tearrepaired with or without the aid of femoral-femoral bypass. These six thenhad muscle flap wound closures at that time or shortly after. All six werehospital survivors and are currently alive. We believe that RV ruptureresults from the sternal edges pulling the anterior surface of the RVapart, since the RV is stuck to the underside of the sternum. Thisexperience indicates that the RV must be freed in all cases during initialsternal debridement. Hopefully this simple maneuver will prevent thishorrendous complication.

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