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Background <p>Minimally invasive cardiac surgery (MICS) reduces surgical trauma but limits direct visualization of surrounding structures, posing a risk of unrecognized injury.</p> Case presentation <p>A 65-year-old man with alcoholic cirrhosis underwent mitral valvuloplasty, tricuspid annuloplasty, and Maze procedure via right mini-thoracotomy. During cardiopulmonary bypass (CPB), progressive reservoir volume loss was noted by a perfusionist. However, no collection of blood was evident in the surgical field, and thus, reservoir volume was maintained with volume transfusion. After weaning from CPB, transesophageal echocardiography (TEE) revealed free fluid around the liver. Exploratory laparoscopy confirmed a 1-cm liver laceration likely caused during a trocar insertion. Hemostasis was achieved surgically, and the patient recovered without complications.</p> Conclusions <p>Iatrogenic liver injury during MICS is rare and may lack intraoperative hemodynamic signs. In this case, timely intraoperative detection of abdominal bleeding using TEE enabled immediate intervention. Routine TEE assessment of intra-abdominal free fluid may help identify similar injuries early and improve patient outcomes.</p>

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Transesophageal echocardiography uncovers iatrogenic liver injury during minimally invasive mitral valve surgery: case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月30日

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  • Toshifumi Yanagi,
  • Patrick Hussey,
  • Kenichi Ueda

摘要

Background

Minimally invasive cardiac surgery (MICS) reduces surgical trauma but limits direct visualization of surrounding structures, posing a risk of unrecognized injury.

Case presentation

A 65-year-old man with alcoholic cirrhosis underwent mitral valvuloplasty, tricuspid annuloplasty, and Maze procedure via right mini-thoracotomy. During cardiopulmonary bypass (CPB), progressive reservoir volume loss was noted by a perfusionist. However, no collection of blood was evident in the surgical field, and thus, reservoir volume was maintained with volume transfusion. After weaning from CPB, transesophageal echocardiography (TEE) revealed free fluid around the liver. Exploratory laparoscopy confirmed a 1-cm liver laceration likely caused during a trocar insertion. Hemostasis was achieved surgically, and the patient recovered without complications.

Conclusions

Iatrogenic liver injury during MICS is rare and may lack intraoperative hemodynamic signs. In this case, timely intraoperative detection of abdominal bleeding using TEE enabled immediate intervention. Routine TEE assessment of intra-abdominal free fluid may help identify similar injuries early and improve patient outcomes.