A Case of Transient ST Elevation Following Intrathoracic Distilled Warm Water Irrigation after Pericardiotomy during Thoracic Surgery

A 53-yr-old man underwent thoracoscopic right lower lobe pneumonectomy for lung cancer. There were no significant events in his medical history or routine preoperative laboratory examinations. During the surgery, pericardial fenestration was performed. Sudden ST elevation in ECG lead Ⅱ with a drop in blood pressure was noted following intrathoracic irrigation with warm distilled water. These events gradually normalized after suction of the water from the pericardial space. His postoperative examination showed normal cardiac function. These events suggest that temporary coronary spasm or pericarditis may occur following invasion of distilled water through the fenestration. This case report suggests that more careful management is required when irrigation with water is performed in the presence of pericardial fenestration.