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Plötzlicher Tod bei Abriss eines LIMA-Bypasses

Sudden death due to avulsion of a LIMA bypass

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Zusammenfassung

Bei koronarangiographisch gesicherter Eingefäßerkrankung am Herzen (betroffenes Gefäß: „left anterior descendens“, LAD) wurde bei einem 48 Jahre alten Mann eine sog. minimal-invasive direkte koronare arterielle Bypassoperation (MIDCAB) am schlagenden Herzen durchgeführt. Am 20. postoperativen Tag kam es unerwartet zur schnell progredienten Kreislaufverschlechterung. Bevor der Tod eintrat, konnte lediglich ein Hämatothorax links aus unklarer Ursache diagnostiziert werden. Bei der gerichtlich angeordneten Obduktion fanden sich 1 l Blut in der linken Brusthöhle sowie Blutkoagel im eröffneten Herzbeutel. Die distalen 4 cm der linken A. mammaria interna (LIMA) waren im Rahmen der Bypassoperation mobilisiert und durch den Herzbeutel geführt worden. An der Innenseite des Herzbeutels zeigte sich der 0,5 cm lange Stumpf der A. mammaria interna, der sich nur unter Zug mit einem korrespondierenden Gefäßstumpf an der Herzvorderwand zusammenführen ließ. Die Anastomose an der LAD stellte sich regelrecht dar. Das Ermittlungsverfahren gegen die Operateure wurde eingestellt. Morphologische und gutachterliche Aspekte des Falles werden dargestellt.

Abstract

A 48-year-old man with proximal stenosis of the left descending artery-underwent minimal invasive direct coronary artery bypass grafting (MIDCAB). However, 20 days after surgery the patient’s conditionsuddenly deteriorated and he died unexpectedly. Prior to death a left-sided hematothorax of unknown origin was diagnosed. The legal autopsy revealed 1 l of blood in the left thoracic cavity and coagulated blood in the pericardium. The distal portion of the left internal mammary artery was mobilized during surgery and carried through the pericardial sac. On the inside of the pericardial sac a short stump of the internal mammary artery appeared, which could only be connected to the corresponding end at the anterior side of the heart under tension. The anastomosis with the left decending artery was correct. Preliminary proceedings against the surgeons involved were terminated. Morphological and medicolegal aspects of the case are described.

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Authors and Affiliations

  1. Institut für Rechtsmedizin, Universitätsklinikum, Hamburg-Eppendorf

    U. M. Balmaceda-Harmelink, J. Matschke &  J. P. Sperhake

  2. Institut für Neuropathologie, Universitätsklinikum, Hamburg-Eppendorf

    J. Matschke

  3. Institut für Rechtsmedizin, Universitätsklinikum, Butenfeld 34, 22529, Hamburg-Eppendorf

    J. P. Sperhake

Authors
  1. U. M. Balmaceda-Harmelink
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  2. J. Matschke
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  3. J. P. Sperhake
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Correspondence to J. P. Sperhake.

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Balmaceda-Harmelink, U.M., Matschke, J. & Sperhake, J.P. Plötzlicher Tod bei Abriss eines LIMA-Bypasses. Rechtsmedizin 15, 92–96 (2005). https://doi.org/10.1007/s00194-005-0309-3

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  • DOI: https://doi.org/10.1007/s00194-005-0309-3

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