[HSF] Posterior aortic bleed

[Nasser F. Abou'Seada]

> From: Jbflegejr at aol.com
> 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.

Dear John 
you mean you have in fact connected the LA through its roof to the leaking
part of the aortic incision ?? .... would you elaborate more on that life
saving technique please ?? 

incidentally ... I presume you have opted to do that with an aortic
annulus/prosthesis mismatch ? avoiding partially explanting the prosthesis
and inserting a gusset to augment the aorta ?? ... would you elaborate more
please ?

NFA

> From: Jbflegejr at aol.com
> Sent: Monday, October 09, 2006 4:48 PM

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