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Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy
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 per...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607617/ https://www.ncbi.nlm.nih.gov/pubmed/34802439 http://dx.doi.org/10.1186/s13019-021-01718-1 |
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author | Hattori, Masashi Matsumura, Yu Yamaki, Fumitaka |
author_facet | Hattori, Masashi Matsumura, Yu Yamaki, Fumitaka |
author_sort | Hattori, Masashi |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8607617 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-86076172021-11-22 Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy Hattori, Masashi Matsumura, Yu Yamaki, Fumitaka J Cardiothorac Surg Case Report 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. BioMed Central 2021-11-21 /pmc/articles/PMC8607617/ /pubmed/34802439 http://dx.doi.org/10.1186/s13019-021-01718-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Case Report Hattori, Masashi Matsumura, Yu Yamaki, Fumitaka Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title | Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title_full | Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title_fullStr | Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title_full_unstemmed | Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title_short | Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
title_sort | massive hemorrhage from the posterior intercostal artery following lower partial sternotomy |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607617/ https://www.ncbi.nlm.nih.gov/pubmed/34802439 http://dx.doi.org/10.1186/s13019-021-01718-1 |
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