[HSF] Intimal Tears

[Nasser F. Abou'Seada]

"Frankly, I'm surprised I've never encountered this complication until now"

Hal
That adds to your critical observance as a surgeon, recognizing the fault
first time seeing it. I faced that situation before in a 55 y old female
having a straight forwards Mitral repair. everything went smoothly yet there
was some bleeding welling up in the pericardium, that we could not come off
bypass ........ all manouvres to find out the source of bleeding were
evading ..... blood seemed to come from around the SVC upper part, where
nothing was ever touched .... patient passed off after some 5 hours on
bypass and blood thinning out. On table autopsy, I dissected around the SVC
up to the IJV.... to find the whole area bathing in blood, ecchymosed ....
and blood perculating through the wall of the vein .. down the sheath ....
around the SVC ..... into the pericardium .. !! .... opening the vein
longitudinally, multiple non peneterating longitudinal tears were found in
the intima of the RIJV ... !!!! ... inquiring in retrospect, the newly
appointed anaesthesiologist tried many times before securing the IJV cannula
in place .... as usual ... mortality was ascribed to the surgeon .... !!!!
... a new lesson with a hard price ..!! .. never forgotten ..

NFA






On Jan 31, 2008 7:09 PM, <Hgrmd at aol.com> wrote:

> Don,
>  My assistant is pretty strong, but I'm not blaming him.   Frankly, I'm
> surprised I've never encountered this complication until now.
>
> Hal
>