AW: AW: [HSF] ACT subtherapeutic in value + Aprotinine-Prasanna´s diagnostic

Tue Feb 5 17:42:31 EST 2008

Excellent!
I saw that once in the 90´s when Aprotinin appeared in the maket. After a
well done mitral valve replacement she was decanulated, protamine given and
all was a clot, inclusive atria, cava, etc, she died. I needed 4 years  to
accept Aprotinin for my cases.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna Simha
M
Gesendet: Dienstag, 5. Februar 2008 15:58
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: AW: [HSF] Intimal Tears

ACT being subtherapeutic in value with Aprotinin and C ACT monitoring at the
end of CPB.
Prasanna
On Feb 5, 2008 8:18 PM, Ben Bidstrup <benjamin.bidstrup at bigpond.com> wrote:

> Roberto, Prasanna
> Can you give me a theoretical basis for aprotinin
> leading to clotting in the pump circuit after
> decannulation?
>
>
>
> >Did the patient get Aprotinin?
> >Hard to think it today...
> >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: Montag, 4. Februar 2008 03:05
> >An: OpenHeart-L at lists.hsforum.com
> >Betreff: Re: [HSF] Intimal Tears
> >
> >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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> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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-- 
Prasanna Simha M
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