Pulmonary vein laceration during radiofrequency ablation for atrial fibrillation in a patient with previous robotic-assisted, minimally invasive mitral valve repair

Abstract

If accumulation of pericardial fluid or blood cannot be stopped with aspiration, then sources of ongoing bleeding or drainage should be evaluated and treated. A multidisciplinary approach is recommended for the best interest of the patient. Introduction Surgical procedures frequently result in a change to the normal anatomy of a patient. These changes must be considered in patients undergoing subsequent surgeries or procedures. Although endoscopic, robotic, and minimally invasive surgeries have decreased the morbidity associated with surgeries from many specialties, these surgeries lead to changes in natural anatomy, just like their more invasive predecessors. For example, minimally invasive mitral valve replacement surgeries traditionally utilize a right anterolateral minithoracotomy in the fourth intercostal space for exposure. Single-lung ventilation with peripheral cannulation and either transthoracic or endoaortic crossclamping is used. After completion of the repair, the decision to close the pericardium is surgeon dependent, as there is currently no consensus regarding its closure. For those unfamiliar with the minimally invasive and robotic approach, a minithoracotomy scar may not elicit the same concerns as a sternotomy scar, although in both surgeries the heart, aorta, and pericardium were involved in and changed as a result of the procedure. We present a case in which anatomic changes, caused by a prior minimally invasive mitral valve repair, altered the early diagnosis and treatment of complications encountered during a radiofrequency atrial fibrillation (AF) ablation. To our knowledge, no similar complication has been described in literature.