[HSF] Intimal Tears

Sun Feb 3 12:21:58 EST 2008

I have cancelled elective cases for carotid injuries--usually cordis/dilator injuries.  Luckily, it has not happened in an emergent case--not sure what to do then...delay, proceed anyway who knows?  What I think we don't hear about from Anesthesia is how often the finder needle hits the carotid.  Maybe this is "innocent" if the needle size is small?!?

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Michael Firstenberg
Sent: Sunday, February 03, 2008 12:15 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Intimal Tears

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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