[HSF] Management of Postop Clotted Hemothorax

[erdinç naseri]

Hal,
2-3 years back I operated a very young patient(29Y/O male for CAD. he had a 
total whitening of the left hemithorax on postop 1.st day( missed by us 
while he was intubated).I was reluctant to reopen him so gave him an 
empirical dose of STK.He stared bleeding from the chest tube and CXR 
remained the same so ı reopened him and cleaned the massive hematoma and 
gave him additional units of blood.Won't repeat it .
erdinc


>From: hgrmd at aol.com
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: [HSF] Management of Postop Clotted Hemothorax
>Date: Sun, 15 Apr 2007 10:29:32 -0400
>
>Dear Members,
>   Last Thursday, I operated on a 47 yo man with severe bicuspid aortic 
>stenosis, 5.2 cm ascending aorta with dilated sinuses, LAD dz, and PAF.  
>Interestingly, at age 6 he had an open aortic valvotomy at Miami 
>Children's. At his insistence, I did a biologic Bentall with a 23mm 
>Perimount sewn to a 28mm Hemoshield, LIMA to the LAD, and a cryomaze.  
>Fresh off CPB, I noticed progression of preop mild MR to 3+ MR.  
>Hemodynamics were marginal, so I went back in and repaired the mitral with 
>a 26 mm Cosgrove.  He then came off easily, the post-CPB TEE showed no MR 
>with an EF of 70%, didn't seem to bleed, and was extubated the next day. 
>Unfortunately, the postop CXR revealed a sizable left hemothorax.  It 
>appeared to occupy about half the chest. I placed a chest tube, but it 
>really didn't drain much.  He currently is saturating well on 3 liters 
>nasal cannula.  My question is:  Does anyone have good experience with 
>instilling streptokinase or urokinase up the chest tube in order to lyse
>   the clot?  If so, what is the protocol.?  Should I just take him back 
>and clean out the left side?
>
>Hal
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