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Preventing heart injury during negative pressure wound therapy in cardiac surgery: assessment using real-time magnetic resonance imaging.

Malmsjö, Malin LU ; Petzina, Rainer LU ; Ugander, Martin LU ; Engblom, Henrik LU ; Torbrand, Christian LU ; Mokhtari, Arash LU ; Hetzer, Roland; Arheden, Håkan LU and Ingemansson, Richard LU (2009) In The Journal of thoracic and cardiovascular surgery 138(3). p.712-717
Abstract
OBJECTIVE: Heart rupture is a devastating complication to negative pressure wound therapy in cardiac surgery. Also, reduced cardiac output during negative pressure wound therapy has been reported. The present study aimed to examine the effects of negative pressure wound therapy on the position of the heart in relation to the thoracic wall using magnetic resonance imaging in a porcine sternotomy wound model. METHODS: Six pigs had median sternotomy followed by negative pressure wound therapy at -75, -125, and -175 mm Hg. Real-time magnetic resonance imaging movies (10 images/s) were acquired in a midventricular transverse plane or a midsagittal plane during the application of negative pressure wound therapy. RESULTS: Similar finding were... (More)
OBJECTIVE: Heart rupture is a devastating complication to negative pressure wound therapy in cardiac surgery. Also, reduced cardiac output during negative pressure wound therapy has been reported. The present study aimed to examine the effects of negative pressure wound therapy on the position of the heart in relation to the thoracic wall using magnetic resonance imaging in a porcine sternotomy wound model. METHODS: Six pigs had median sternotomy followed by negative pressure wound therapy at -75, -125, and -175 mm Hg. Real-time magnetic resonance imaging movies (10 images/s) were acquired in a midventricular transverse plane or a midsagittal plane during the application of negative pressure wound therapy. RESULTS: Similar finding were observed at all different negative pressures studied. Negative pressure wound therapy caused the heart to be displaced toward the thoracic wall, and in some cases, the right ventricular free wall bulged into the space between the sternal edges, and the sharp edges of the sternum jutted into and deformed the anterior surface of the right ventricular free wall. These events were not affected by the interposition of 4 layers of paraffin gauze dressing but were hindered by the placement of a rigid barrier between the anterior portion of the heart and the inside of the thoracic wall. CONCLUSION: The results show altered position of the heart in relation to the sternum during negative pressure wound therapy. This may explain 2 potentially hazardous events associated with negative pressure wound therapy, namely, risk for heart rupture and reduced cardiac output. Inserting a rigid barrier over the heart may be a protective measure that is clinically practicable. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of thoracic and cardiovascular surgery
volume
138
issue
3
pages
712 - 717
publisher
Mosby
external identifiers
  • WOS:000269323000028
  • PMID:19698860
  • Scopus:68749114991
ISSN
1097-685X
DOI
10.1016/j.jtcvs.2008.11.068
language
English
LU publication?
yes
id
278f16d5-f6b8-4257-b687-f4dbc0d3d048 (old id 1469498)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19698860?dopt=Abstract
date added to LUP
2009-09-07 15:38:17
date last changed
2016-10-13 04:25:12
@misc{278f16d5-f6b8-4257-b687-f4dbc0d3d048,
  abstract     = {OBJECTIVE: Heart rupture is a devastating complication to negative pressure wound therapy in cardiac surgery. Also, reduced cardiac output during negative pressure wound therapy has been reported. The present study aimed to examine the effects of negative pressure wound therapy on the position of the heart in relation to the thoracic wall using magnetic resonance imaging in a porcine sternotomy wound model. METHODS: Six pigs had median sternotomy followed by negative pressure wound therapy at -75, -125, and -175 mm Hg. Real-time magnetic resonance imaging movies (10 images/s) were acquired in a midventricular transverse plane or a midsagittal plane during the application of negative pressure wound therapy. RESULTS: Similar finding were observed at all different negative pressures studied. Negative pressure wound therapy caused the heart to be displaced toward the thoracic wall, and in some cases, the right ventricular free wall bulged into the space between the sternal edges, and the sharp edges of the sternum jutted into and deformed the anterior surface of the right ventricular free wall. These events were not affected by the interposition of 4 layers of paraffin gauze dressing but were hindered by the placement of a rigid barrier between the anterior portion of the heart and the inside of the thoracic wall. CONCLUSION: The results show altered position of the heart in relation to the sternum during negative pressure wound therapy. This may explain 2 potentially hazardous events associated with negative pressure wound therapy, namely, risk for heart rupture and reduced cardiac output. Inserting a rigid barrier over the heart may be a protective measure that is clinically practicable.},
  author       = {Malmsjö, Malin and Petzina, Rainer and Ugander, Martin and Engblom, Henrik and Torbrand, Christian and Mokhtari, Arash and Hetzer, Roland and Arheden, Håkan and Ingemansson, Richard},
  issn         = {1097-685X},
  language     = {eng},
  number       = {3},
  pages        = {712--717},
  publisher    = {ARRAY(0x85f1ef8)},
  series       = {The Journal of thoracic and cardiovascular surgery},
  title        = {Preventing heart injury during negative pressure wound therapy in cardiac surgery: assessment using real-time magnetic resonance imaging.},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2008.11.068},
  volume       = {138},
  year         = {2009},
}