[HSF] Intimal Tears

Mon Feb 4 20:56:09 EST 2008

Ah Roberto, the midnight carotid direct stick angio with contralateral
compression to rule out a subdural hematoma was one of the  High points
before we got CT scanning done routinely !!
Prasanna

On Feb 4, 2008 12:50 PM, Dr. Roberto Battellini <
battr at medizin.uni-leipzig.de> wrote:

> No, we do not if the carotid is punctured only once, they recognize it and
> there is no haematoma. The older surgeons can remember that the first
> carotid angiographies were done by punction.
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Michael
> Firstenberg
> Gesendet: Sonntag, 3. Februar 2008 18:15
> An: OpenHeart-L at lists.hsforum.com
> Betreff: 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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-- 
Prasanna Simha M