A Case Of Ruptured Diverticulum Of The Left Ventricle With Hemopericardium In A Neonate, Treated Successfully By Surgery

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Abstract
The case of a newborn girl, who had recurrent attacks of cyanosis and dyspnoe from the 4th day of life is described. The heart was steadily enlarging on the radiograph. A diagnosis of congenital malformation could not be confirmed. An aspiration of the pericardial sac on the 21th day of life awoke a suspicion of a hemo-pericardium. Operation disclosed a large amount of old clots in the pericardial sac compromising the heart. By removing the clots a violent bleeding from what was probably a ruptured diverticulum of the left ventricle appeared. This bleeding was followed by a cessation of the heart activity. After closure of the rupture, of about the same size as the tip of the surgeons little finger, blood-transfusion, different repeated heartstimuli and heartmassage were applied. The time which passed before spontaneous heartaction started again was estimated to be about 15 min. Postoperatively the patient was treated in an incubator and a respirator. The patient seems to have escaped without brain damage. Different aspects of the diagnosis, etiology, casuistry and therapy are discussed. This patient seems to be the first with a ruptured diverticulum of the heart and a hemopericardium, who has been saved by surgery. It also seems to be the first case which shows the clinical picture of a spontaneous hemopericardium caused by a delayed rupture of the heart.

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