Right ventricular myocardial edema leading to severe heart failure after open heart surgery - possible effect of high-dose corticosteroid therapy

• Published in: Journal of cardiothoracic surgery Vol. 19; no. 1; p. 179
• Main Authors: Jeppesen, Karoline Korsholm, Riber, Lars Peter, Dahl, Jordi Sanchez
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.04.2024; BioMed Central; BMC
• Subjects: Angiography; Aorta; Aortic dissection; Cardiac patients; Case reports; Congestive heart failure; Coronary artery; Coronary vessels; Corticosteroid treatment; Corticosteroids; Dissection; Dosage and administration; Dropsy; Echocardiography; Edema; Health aspects; Heart; Heart failure; Heart surgery; Hemodynamics; Homeostasis; Infections; Inflammation; Inflammatory response; Ischemia; Mediastinitis; Myocardial edema; Myocardium; Patients; Prostheses; Reperfusion; Sternum; Steroids; Surgery; Systematic review; Ventricle; Heart failure; Aortic dissection; Myocardial edema; Corticosteroid treatment
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-02656-4

Cardiopulmonary bypass induces a systemic inflammatory response and alterations in fluid homeostasis, resulting in generalized tissue edema. Additionally, ischemia-reperfusion injury following cardioplegic arrest presumably prompts organ-specific myocardial edema. The case report presents a 75-year-old Caucasian male diagnosed with aortic dissection, Stanford type A, who underwent complicated open-heart surgery. Postoperatively, the patient developed excessive myocardial edema, particularly affecting the right ventricle myocardium to an extent where the right ventricle surpassed the sternal rim, making it impossible to close the sternum. Ischemia was ruled out by performing coronary angiography, demonstrating well-calibrated coronary arteries. Transoesophageal echocardiography showed a restrictive right ventricle with free-wall thickness of 30 mm, severely reduced right ventricle systolic function and a volume-depleted left ventricle consistent with right ventricular heart failure due to right ventricular edema. The patient presented with unstable haemodynamics despite use of inotropes and continuation of open sternotomy. In an attempt to reduce myocardial edema, the patient was started on corticosteroid treatment despite of ongoing mediastinitis. Corticosteroid treatment reduced myocardial edema and enabled the closure of sternum on the 44th postoperative day. The case report addresses the clinical relevance of corticosteroid treatment in selective cases of intractable haemodynamically significant postoperative myocardial edema.