[HSF] Intimal Tears

[Macbook]

We don't. They change side while someone makes some compression on  
the neck.

Il giorno 03/feb/08, alle ore 18:15, Michael Firstenberg ha scritto:

> Right before the STS, I took a partners patient back for a huge right
> hemothorax.  He was 2 weeks post-op (double valve endocarditis),  
> doing fine,
> and the only thing recent was a new right neck line by the  
> Cardiology team
> (he was waiting for a pacemaker on their service.....long story and  
> not for
> now)
>
> Which begs the question - if Anesthesia hits the carotid (finder  
> needle,
> introducer, whatever) - will people postpone the case?
> (I know an open and vague question - but am interested in the  
> responses)
>
>
>
>
> -michael
>
>
> On 2/3/08, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>  
> wrote:
>>
>> Giuseppe,
>> I had the same experience twice. But if you open the pleura and  
>> look at
>> the
>> haematoma, you will recognize the problem. Of course, the one who  
>> put the
>> catheter will not...It is a not uncommon complication of jugular
>> indwelling
>> catheters.
>> I agree, it is better for the patient to admit errors.
>> Roberto
>>
>> -----Ursprüngliche Nachricht-----
>> Von: openheart-l-bounces at lists.hsforum.com
>> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Macbook
>> Gesendet: Sonntag, 3. Februar 2008 16:32
>> An: OpenHeart-L at lists.hsforum.com
>> Betreff: 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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