RESUMO
Oesophageal balloon tamponade tubes are a rare cause of ST-segment elevation (STE), thought to result from extrinsic compression of coronary arteries. This case describes STE following the use of a Sengstaken-Blakemore tube (SBT) under traction for management of bleeding oesophageal varices during orthotopic liver transplantation. This case is the first to report a significant troponin rise with STE indicative of myocardial injury following the use of SBT. Interestingly, we found that releasing traction from the SBT resulted in resolution of STE within minutes, suggesting that SBT traction may reversibly impede coronary perfusion. We recommend vigilant monitoring of patients following SBT insertion and for clinicians to consider that SBT traction may impair coronary perfusion and result in myocardial injury in patients without pre-existing coronary artery disease.
Assuntos
Oclusão com Balão/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Transplante de Fígado/efeitos adversos , Isquemia Miocárdica/etiologia , Drenagem , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 38-year-old intravenous drug using man was scheduled for urgent pericardial window surgery to treat pericardial effusion and tamponade. Transoesophageal echocardiography (TOE) during the procedure revealed a minor residual effusion and an atypical heterogenous thickened appearance of the pericardium and adjoining aortic root. Interrogation of the aortic valve with a 'panning' manoeuvre from the mid-oesophageal aortic valve short axis view showed a small hypoechoic lesion between the right and non-coronary cusp at the level of the sinus of Valsalva. Postoperative high-resolution contrast CT confirmed the anaesthesia TOE findings of a small pseudoaneurysm. The decision was then made to proceed to formal aortic root replacement after 5 days of directed antibiotic therapy and evidence of an increase in aneurysm size to 2.7 cm on repeat CT angiogram. The patient made a good postoperative recovery and was eventually discharged from the hospital 3 weeks after his second operation.