[HSF] Intimal Tears

Sun Feb 3 19:23:13 EST 2008

Actually, a covered stent is an excellent solution. We had to do that for a 
cachectic old lunger for whom surgery was not an option. This was when the 
Viabahn( ? sp) was still investigational and we had to get a compassionate 
use permit for it. Just a little ancient history.
MitchAt 11:30 AM 2/3/2008, you wrote:
>I was involved with a heart-lung transplant where an excellent team put an
>introducer into the subclavian artery (she had abnormal anatomy to begin
>with) - we just left it in for a day or two then vascular put in a covered
>stent (would not have been my first choice - as I would have done a primary
>repair in the OR - but that is since we deal with axillary artery
>cannulation all of the time).  She did fine
>
>
>-michael
>
>
>On 2/3/08, Crittenden, Michael <Michael.Crittenden at va.gov> wrote:
> >
> > 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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