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...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-021-01718-1 |
| _version_ | 1818851400792145920 |
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| author | Masashi Hattori Yu Matsumura Fumitaka Yamaki |
| author_facet | Masashi Hattori Yu Matsumura Fumitaka Yamaki |
| author_sort | Masashi Hattori |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-19T07:04:26Z |
| format | Article |
| id | doaj.art-1d48950e92e1479db0869e32eed56f8e |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-19T07:04:26Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-1d48950e92e1479db0869e32eed56f8e2022-12-21T20:31:19ZengBMCJournal of Cardiothoracic Surgery1749-80902021-11-011611410.1186/s13019-021-01718-1Massive hemorrhage from the posterior intercostal artery following lower partial sternotomyMasashi Hattori0Yu Matsumura1Fumitaka Yamaki2Department of Cardiovascular Surgery, Nagano Chuo HospitalDepartment of Cardiovascular Surgery, Nagano Chuo HospitalDepartment of Cardiovascular Surgery, Nagano Chuo HospitalAbstract 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.https://doi.org/10.1186/s13019-021-01718-1Lower partial median sternotomyPost-sternotomy hemorrhagePosterior intercostal artery bleedingSternal retractionBleeding |
| spellingShingle | Masashi Hattori Yu Matsumura Fumitaka Yamaki Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy Journal of Cardiothoracic Surgery Lower partial median sternotomy Post-sternotomy hemorrhage Posterior intercostal artery bleeding Sternal retraction Bleeding |
| 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 | Lower partial median sternotomy Post-sternotomy hemorrhage Posterior intercostal artery bleeding Sternal retraction Bleeding |
| url | https://doi.org/10.1186/s13019-021-01718-1 |
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