Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy

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 canno...

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Autores principales: Masashi Hattori, Yu Matsumura, Fumitaka Yamaki
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Publicado: BMC 2021
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spelling oai:doaj.org-article:1d48950e92e1479db0869e32eed56f8e2021-11-28T12:30:55ZMassive hemorrhage from the posterior intercostal artery following lower partial sternotomy10.1186/s13019-021-01718-11749-8090https://doaj.org/article/1d48950e92e1479db0869e32eed56f8e2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13019-021-01718-1https://doaj.org/toc/1749-8090Abstract 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.Masashi HattoriYu MatsumuraFumitaka YamakiBMCarticleLower partial median sternotomyPost-sternotomy hemorrhagePosterior intercostal artery bleedingSternal retractionBleedingSurgeryRD1-811AnesthesiologyRD78.3-87.3ENJournal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-4 (2021)
institution DOAJ
collection DOAJ
language EN
topic Lower partial median sternotomy
Post-sternotomy hemorrhage
Posterior intercostal artery bleeding
Sternal retraction
Bleeding
Surgery
RD1-811
Anesthesiology
RD78.3-87.3
spellingShingle Lower partial median sternotomy
Post-sternotomy hemorrhage
Posterior intercostal artery bleeding
Sternal retraction
Bleeding
Surgery
RD1-811
Anesthesiology
RD78.3-87.3
Masashi Hattori
Yu Matsumura
Fumitaka Yamaki
Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy
description 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.
format article
author Masashi Hattori
Yu Matsumura
Fumitaka Yamaki
author_facet Masashi Hattori
Yu Matsumura
Fumitaka Yamaki
author_sort Masashi Hattori
title 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_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_sort massive hemorrhage from the posterior intercostal artery following lower partial sternotomy
publisher BMC
publishDate 2021
url https://doaj.org/article/1d48950e92e1479db0869e32eed56f8e
work_keys_str_mv AT masashihattori massivehemorrhagefromtheposteriorintercostalarteryfollowinglowerpartialsternotomy
AT yumatsumura massivehemorrhagefromtheposteriorintercostalarteryfollowinglowerpartialsternotomy
AT fumitakayamaki massivehemorrhagefromtheposteriorintercostalarteryfollowinglowerpartialsternotomy
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