[HSF] Intimal Tears

[Prasanna Simha M]

Was the protamine drip connected ?
People have given Protamine instead of Heparin .(could have been given by a
mislabeled syringe on either the anesthesiology side or perfusion side)
Was Aprotinin or any other procoagulant used ? (I presume not in the US.)
Incidentally what were you still deairing with the venous cannula out and
off CPB after the case is finished ?
Prasanna

On Feb 4, 2008 7:35 AM, Michael Firstenberg <msfirst at gmail.com> wrote:

> Speaking of anesthesia "issues" - I had a complex case the other
> day.  We were off pump, the venous cannula was out, but the arterial
> was still in and we were still de-airing.  No clot in the field (long
> pump run, circ arrest), but after a few minutes Perfusion told me the
> oxygenator and arterial line was clotted.  Anesthesia insisted
> protamine had not been given...... comments?
>
> I have my thoughts.....
>
>
> -michael
>
>
>
> On Feb 3, 2008, at 8:15 PM, Mitch Lirtzman wrote:
>
> > I too, have had the unenviable experience. As I suspect we all have
> > at one time or another. With the same anesthesiologist, he hit and
> > placed the sheath in the carotid. First case, he pulled the sheath
> > and as I entered the room, I saw him with two sopping red laps on
> > the neck. Second case, I told him to leave the sheath in place. I
> > did a real easy cut down placed a 5-0 purse-string and pulled the
> > sheath. Went on with the case. Needle punctures don't bother me. I
> > have since nicknamed him "The Assassin".
> > Mitch At 11:15 AM 2/3/2008, you wrote:
> >> 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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-- 
Prasanna Simha M