scholarly journals Massive Hemorrhage From the Posterior Intercostal Artery Following Lower Partial Sternotomy: a Case Report

2021 ◽  
Author(s):  
Masashi Hattori ◽  
Yu Matsumura ◽  
Fumitaka Yamaki
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Rare Complication ◽  
Massive Hemorrhage ◽  
Intercostal Artery ◽  
Partial Sternotomy ◽  
The Right ◽  
Superior Approach ◽  
Enhanced Computed Tomography

Abstract Background: In recent years, partial sternotomy has been adopted as an approach for minimally invasive cardiac surgery. Lower partial sternotomy is considered a superior approach compared to full sternotomy in terms of postoperative sternum fixation. We reported a very rare complication of posterior intercostal bleeding after aortic valve replacement with lower partial sternotomy.Case presentation: A 79-year-old man underwent aortic valve replacement using lower partial sternotomy involving the right second intercostal space. The surgery was completed without any problem. However, a postoperative chest radiograph indicated a hematoma in the right upper chest wall and pleural effusion. Therefore, we inserted a drainage tube immediately. His blood pressure gradually decreased despite not having much drainage from the chest tube. Contrast-enhanced computed tomography revealed a huge hematoma and hemorrhage from the fourth right posterior intercostal artery. Immediately, we performed an emergency lower partial sternotomy again. We detected the origin of the bleeding in the right fourth posterior intercostal artery and obtained hemostasis with direct suture. The postoperative course was uneventful.Conclusions: This case highlights the possibility of intraoperative bleeding from the intercostal artery, even in the absence of a clear rib fracture. In our case, we did not identify the cause of the bleeding. However, we suggest that the inhomogeneous stress on the posterior ribs upon attaching the sternal retractor for lower partial sternotomy may have affected the posterior intercostal artery.

scholarly journals Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Masashi Hattori ◽  
Yu Matsumura ◽  
Fumitaka Yamaki
Keyword(s):  
Minimally Invasive ◽  
Cardiovascular Surgery ◽  
Median Sternotomy ◽  
Massive Hemorrhage ◽  
Intercostal Artery ◽  
Intraoperative Bleeding ◽  
Partial Sternotomy ◽  
Contrast Enhanced ◽  
The Right ◽  
Enhanced Computed Tomography

Abstract Background Median sternotomy remains the most common approach in cardiovascular surgery. Recently, minimally invasive procedures, such as minimally invasive cardiac surgery, robot surgery, and catheter therapy have been developed in cardiovascular surgery. However, all these surgeries cannot be performed by minimally invasive approaches. Several complications associated with median sternotomy have been reported, although post-sternotomy hemorrhage from the posterior intercostal artery is extremely rare. Case presentation We present a case of posterior intercostal artery bleeding following lower partial sternotomy. A 79-year-old man underwent aortic valve replacement using lower partial median inverted L-shaped sternotomy that cut into the right second intercostal space. A postoperative chest radiograph indicated a hematoma in the right upper chest wall and pleural effusion. Hence, we inserted a drainage tube immediately. Approximately 2 hours after the surgery, his blood pressure gradually decreased. Blood drainage was observed from the tube, and the amount of blood drainage was not large. Contrast-enhanced computed tomography revealed a huge hematoma and hemorrhage from the fourth right posterior intercostal artery. Immediately, we performed emergency surgery. The lower partial sternotomy was repeated. We detected the origin of the bleeding that was identified in the right fourth posterior intercostal artery, and the bleeding was stopped. The postoperative course was uneventful. Conclusions This case highlights the possibility of intraoperative bleeding from the intercostal artery, even in the absence of clearly rib fracture. In our case, we did not identify the cause of bleeding, although we suggest the inhomogeneous stress on the posterior ribs upon attaching the sternal retractor for lower partial sternotomy may have affected the posterior intercostal artery.

scholarly journals Obstruction of 2 Coronary Arteries from Different Causes Immediately after Transapical Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 47 (1) ◽  
pp. 30-34
Author(s):  
Umihiko Kaneko ◽  
Ryuji Koshima ◽  
Hirosato Doi ◽  
Tsutomu Fujita
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Rare Complication ◽  
Left Main ◽  
Transcatheter Aortic Valve

Coronary obstruction, a rare complication of transcatheter aortic valve replacement, can be fatal. Few data exist on this phenomenon, and, to date, authors have reported only single coronary lesions. We present a case in which 2 coronary arteries obstructed immediately after transapical transcatheter aortic valve replacement. The patient was an 81-year-old woman with symptomatic severe aortic stenosis who underwent transapical transcatheter aortic valve replacement. Immediately after an Edwards Sapien XT valve was deployed, she experienced sudden cardiogenic shock resulting from obstruction of the left main coronary artery ostium and the distal left anterior descending coronary artery. The left main obstruction was caused by direct compression from a large calcified mass and the valve frame. The left anterior descending coronary artery obstruction was caused by ambient myocardial tightening and external compression around the apical sutures. Revascularization was achieved through coronary stent placement and suture removal, respectively. Our patient's case highlights the risk for coronary obstructions after transapical transcatheter aortic valve replacement, and we discuss how they can be managed.

scholarly journals Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis

2019 ◽  
Vol 30 (3) ◽  
pp. 424-430 ◽  
Author(s):  
Masayoshi Tokoro ◽  
Sadanari Sawaki ◽  
Takahiro Ozeki ◽  
Mamoru Orii ◽  
Akihiko Usui ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operating Time ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Intercostal Space ◽  
Anterolateral Approach ◽  
The Right

Abstract OBJECTIVES Totally endoscopic aortic valve replacement (AVR) is still a challenging operation, and only a few series reports exist in the literature. The purposes of this study were to establish a method for endoscopic AVR and evaluate its initial results. METHODS A total of 47 patients (median age 76 years, 17 men) underwent endoscopic AVR. The main wound was created in the right anterolateral 4th intercostal space through a 4-cm skin incision. No rib spreader was used. A 3-dimensional endoscope was inserted at the midaxillary line. A 5.5-mm trocar was inserted in the 3rd intercostal space, thus creating a 3-port setting similar to that used for endoscopic mitral valve surgery. A standard prosthesis was used, and the sutures were tied using a knot pusher. Results were compared with those of 157 patients who underwent right transaxillary AVR with direct vision plus endoscopic assist. RESULTS Patient backgrounds did not differ significantly between the 2 groups. No deaths occurred in the entire series. There was no conversion to thoracotomy or sternotomy in the endoscopic AVR group. The complication rate did not differ significantly between the 2 groups. The total operating time was significantly shorter in endoscopic AVR (188–206 min); the cardiopulmonary bypass time (130–128 min) and the cross-clamp time (90–95 min) did not differ significantly (median, endoscopic AVR, right transaxillary AVR). Two patients underwent endoscopic double-valve (aortic and mitral) surgery under the same conditions. CONCLUSIONS Endoscopic AVR was possible through 3 ports created in the right anterolateral chest, similar to the procedure for endoscopic mitral valve surgery. By adopting a common approach for both the aortic and the mitral valve operations, endoscopic double-valve surgery can be performed seamlessly.

Sutureless Aortic Valve Replacement via Partial Sternotomy

2010 ◽  
Vol 5 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Sven Martens ◽  
Andreas Zierer ◽  
Anja Ploss ◽  
Sami Sirat ◽  
Aleksandra Miskovic ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
Minimal Invasive ◽  
Partial Sternotomy ◽  
Sutureless Valve ◽  
Valve Implantation

Objective For elderly patients with symptomatic aortic valve stenosis, aortic valve replacement with tissue valves is still the treatment of choice. Stentless valves were introduced to clinical practice for better hemodynamic features as compared with stented tissue valves. However, the implantation is more complex and time demanding, especially in minimal invasive aortic valve replacement. We present our clinical data on 22 patients having received a sutureless ATS 3f Enable aortic bioprosthesis via partial upper sternotomy. Methods The procedure was performed using CPB with cardioplegic arrest. After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2). Results Implantation of the valve required 10 ± 6 minutes. Cardiopulmonary bypass and aortic crossclamp time were 87 ± 16 and 55 ± 11 minutes, respectively. Early mortality (<90 days) was 9% (2 patients). No paravalvular leakage was detected intraoperatively or in follow-up echocardiography. The mean transvalvular gradients were 9 ± 6 mm Hg at discharge and 8 ± 2 mm Hg at 1-year follow-up. Conclusions Sutureless valve implantation via partial sternotomy is feasible and safe with the ATS 3f Enable bioprosthesis. Reduction of cardiopulmonary bypass and aortic crossclamp time seems possible with increasing experience. Hemodynamic data are very promising with low gradients at discharge and after 12 month. Sutureless valve implantation via minimal invasive access may be an alternative treatment option for elderly patients with high comorbidity.

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