A 66-year-old female patient underwent surgery because of a large paraesophageal hiatal hernia. Just prior to the fundal wrap of the Nissen fundoplication, the patient suddenly became tachycardic and profoundly hypotensive. Emergency sternotomy revealed hemopericardium and a 2-cm laceration of the diaphragmatic surface of the right ventricle, which was controlled by placement of several sutures. The authors believed that the injury to the heart was secondary to a perforating needle on the contracting ventricle. The patient could be discharged from hospital on postoperative day 21.
A 46-year-old man with gastroesophageal reflux disease underwent Nissen fundoplication with hiatal mesh reinforcement using absorbable tacks. Forty-eight hours after surgery, the patient developed hypotension and sweating. Cardiac magnetic resonance imaging showed a large pericardial effusion. Pericardiocentesis was performed with removal of 650 cc of bloody fluid. The pericardial drain could be removed two days later. The patient’s further course was uneventful.