[HSF] Intimal Tears

[Prasanna Simha M]

Last week I had an unexplained retro IVC bleed that I could stop by two
purse strings , one in the RIPV IVC junction and the other around the IVC RA
LA junction at the oblique sinus. Now I wonder  if it could have been due to
something like this . (Though I didn't see any flap on TEE)
Prasanna

On Feb 1, 2008 12:29 PM, Nasser F. Abou'Seada <nfaabouseada at gmail.com>
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
> >
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-- 
Prasanna Simha M