[HSF] Intimal Tears

[Macbook]

Michael,

I said that there was a bleeding I was unable to explain... they were  
very kind and trusty


Il giorno 03/feb/08, alle ore 16:55, Michael Firstenberg ha scritto:

> We are the only ones who do procedures which result in  
> complications.  You should know that by now.
>
> By the way - what did you tell the family?
>
>
> Michael Firstenberg <msfirst at gmail.com>
>
> -----Original Message-----
> From: "Macbook" <grescigno at mac.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: 2/3/2008 10:32 AM
> Subject: Re: [HSF] Intimal Tears
>
> Nasser,
>
> two weeks ago a did an AVR + PFO closure in a quite young woman
> (about 50). My resident opened the patient and did a large opening of
> the right pleura. At the end of the procedure I sucked almost 1 liter
> of blood from the right pleural cavity (I said to myself that this
> was blood collected during the operation). The day after the patient
> was extubated and well but there was still some bleeding from the
> right chest tube. The patient was reexplored by a collegue who found
> nothing. The patient continued to bleed and on postop day 2 I
> reexplored the woman. I found a bleeding spot from the apex of the
> parietal pleura. It was clearly related to the IJV catheter but the
> anesthesist said that it was related to surgery!!! BTW I put two
> stitches and stopped the bleeding. However, as the blood was quite
> red and I was worried about an arterial lesion I asked the vascular
> surgeon to do an intraoperative arteriography that was negative. The
> patient luckily did very well. We all make mistakes but it is nice to
> admit them.
>
> Giuseppe
>
>
> Il giorno 01/feb/08, alle ore 07:59, Nasser F. Abou'Seada ha scritto:
>
>> "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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