[HSF] Intimal Tears

[Donald Ross]

That is an important lesson, Nasser.
I have had a patient despatched with  a dissected carotid artery  
after an IJ  stab oops!
Don
On 01/02/2008, at 5:59 PM, Nasser F. Abou'Seada wrote:

> "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
>>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the  
> policies and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------