[HSF] Posterior aortic bleed and Coronarybutton tears.

[Nasser F. Abou'Seada]

Prasanna 
if you are sure that your stitches are OK and that there is no bleeding
EXCEPT when the pressure is High, meaning that there is no surgical cause,
except "geometrical conformational changes with high pressure"  I used to
keep the pressure in the 90 systolic - there should be no bleeding then ....
- reverse Heparin meticulously, FFP, Platelets, and the MAGIC ULTRA-FRESH
Whole blood, in addition to the patient's own blood -if harvested-  .....
meanwhile inserting Surgicel and packing over. The idea is to prevent
bleeding and tamponade  subsequent to Consumption Coagulopathy that might
result from minor operative bleeding ...... IMHO ... having the LEVELS of
coagulation factors -including factor 4 and 8- and platelets  built up
SYNCHRONOUSLY ... would do the trick.
I've tried that thousands of times, during my residency training ..... it
worked .... all the times .... "I should be thankful to those whom I have
been assisting ..!!" ... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Monday, October 09, 2006 9:24 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Posterior aortic bleed and Coronarybutton tears.
> 
> John,
>  I actually had kept a pack exactly as you had said but the patient
> still bled and nearly tamponaded !! I had to withdraw the pack and then
> shifted the patient to the OR. What "trick is there while packing ?
> Prasanna
> Jbflegejr at aol.com wrote:
> > I have manaed several posterior aortic bleeds resulting from too
vigorous
> > removal of calcium from the aortic root or at the lower end of the
aortotomy
> > carried deep into the noncoronary sinus by diverting them into the left
atrium.
> > With the patient on bypass,  an incision is made in the roof to the left
atrium
> > and the edge sutured to the aortic root distal to the leaking area. This
has
> > been lifesaving and has never resulted in a persistent fistula. I have
not done
> > this in recent years having become more careful in avoiding the problem.
> > Another method that I have used on occasion is gauze packing. Using one
inch
> > vaginal packing, I have packed the area at the aortic root over the roof
of the
> > left atrium and between the aorta and right atrium and brought the end
of the
> > packing through the chest wall and after a day or two started pulling it
out a
> > few inches at a time two or three times a day. Usually about three feet
of
> > packing was used. I never saw recurrent bleeding with either technique.
John Flege
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