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Intraoperative extrinsic left atrial compression due to paraesophageal hiatal hernia
Compresión extrínseca de la aurícula izquierda intraoperatoria por hernia de hiato paraesofágica
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Plano apical 5 cámaras donde se evidencia el colapso de la aurícula izquierda por una masa extracardiaca (flechas blancas). B) Plano apical donde se aplica Doppler color sobre la válvula mitral. Parámetros ecocardiográficos obtenidos: Flujo mitral onda E 0,5<span class="elsevierStyleHsp" style=""></span>m/s; onda A 0,7<span class="elsevierStyleHsp" style=""></span>m/s. Integral velocidad/tiempo del tracto de salida del ventrículo izquierdo (IVT/TSVI): 14<span class="elsevierStyleHsp" style=""></span>cm. Doppler tisular en anillo lateral mitral: onda E mitral 0,12<span class="elsevierStyleHsp" style=""></span>m/s. <span class="elsevierStyleSmallCaps">C</span>) Corte transversal de la TAC torácica que evidencia una gran hernia paraesofágica que comprime e impide el llenado de la aurícula izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Benlloch Beitia, I. Carpi Femenia, C. Ivars Párraga, L. 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Benlloch Beitia, I. Carpi Femenia, C. Ivars Párraga, L. González Pérez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Benlloch Beitia" "email" => array:1 [ 0 => "aidabenllochbeitia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Carpi Femenia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Ivars Párraga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "González Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Francisco de Borja, Gandía, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital de Dénia-Marina Salud, Denia, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Compresión extrínseca de la aurícula izquierda intraoperatoria por hernia de hiato paraesofágica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2602 "Ancho" => 2362 "Tamanyo" => 310928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic ultrasound. Apical 5-chamber view showing the collapse of the left atrium by a noncardiac mass (white arrows). (B) Apical view where colour Doppler is applied to the mitral valve. Ultrasound parameters obtained: E-wave mitral flow 0.5<span class="elsevierStyleHsp" style=""></span>m/s; A-wave 0.7<span class="elsevierStyleHsp" style=""></span>m/s. Left ventricular outflow tract velocity-time integral: 14<span class="elsevierStyleHsp" style=""></span>cm. Tissue Doppler in lateral mitral ring: mitral E-wave 0.12<span class="elsevierStyleHsp" style=""></span>m/s. (C) Chest CT scan cross-section showing a large paraesophageal hernia compressing and preventing filling of the left atrium.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0020" class="elsevierStylePara elsevierViewall">A 60-year-old man with a history of hiatal hernia who had undergone inguinal hernia repair 1 year previously presented with hernia recurrence, so open inguinal hernia repair re-intervention was scheduled. Balanced general anaesthesia without neuromuscular relaxation was administered and an i-gel laryngeal mask was used for airway management. Forty-five minutes after induction, the patient presented shock with hypotension, decreased end-tidal CO<span class="elsevierStyleInf">2</span>, hypoxaemia and ST elevation on ECG. Resuscitation was started with scant haemodynamic improvement, so surgery was terminated and the patient was moved to the ICU. To facilitate the diagnosis of shock, we performed a transthoracic echocardiography, which showed an extracardiac “pseudo-mass” that prevented filling and emptying of the left atrium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). A CT scan enabled us to pinpoint the origin, which was a large paraoesophageal hiatal hernia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The patient was stabilized following intravenous fluid administration and removal of air from the stomach via a nasogastric tube. We believe the laryngeal mask airway caused insufflation of air into the stomach, thus precipitating compression of the left atrium.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Benlloch Beitia A, Carpi Femenia I, Ivars Párraga C, González Pérez L. Compresión extrínseca de la aurícula izquierda intraoperatoria por hernia de hiato paraesofágica. Rev Esp Anestesiol Reanim. 2017;64:299–300.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0015" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2602 "Ancho" => 2362 "Tamanyo" => 310928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Transthoracic ultrasound. Apical 5-chamber view showing the collapse of the left atrium by a noncardiac mass (white arrows). (B) Apical view where colour Doppler is applied to the mitral valve. Ultrasound parameters obtained: E-wave mitral flow 0.5<span class="elsevierStyleHsp" style=""></span>m/s; A-wave 0.7<span class="elsevierStyleHsp" style=""></span>m/s. Left ventricular outflow tract velocity-time integral: 14<span class="elsevierStyleHsp" style=""></span>cm. Tissue Doppler in lateral mitral ring: mitral E-wave 0.12<span class="elsevierStyleHsp" style=""></span>m/s. (C) Chest CT scan cross-section showing a large paraesophageal hernia compressing and preventing filling of the left atrium.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1638119 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] 2 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 1199494 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006400000005/v1_201704260038/S2341192917300410/v1_201704260038/en/main.assets" "Apartado" => array:4 [ "identificador" => "65600" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images ot the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006400000005/v1_201704260038/S2341192917300410/v1_201704260038/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192917300410?idApp=UINPBA00004N" ]
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