Clinical Practice
A Trick to Control the Bleeding in Cardiovascular Surgery Yi‑Ming Ni1, Bold Altangerel2, Hong‑Fei Xu1, Hai‑Ge Zhao1 1
Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of the Zhejiang University, Hangzhou, Zhejiang 310000, China 2 Department of Thoracic Surgery, National Cancer Center, Bayanzurkh District, Ulaanbaatar, Mongolia
Key words: Bleeding; Thymus Gland; Vena Cava Cannulation
When accidental bleeding happens on the posterior wall of vena cava during the procedure of vena cava cannulation [Figure 1a], two pieces of thymus gland tissue around 2 cm × 1 cm were taken as the mattress tips, and these two pieces of tissue were put aside the bottom of vena cava, then use Prolene (Ethicon, Somerville, NJ, USA) to pass through the interspace under the posterior wall to make a mattress suture [Figure 1b and c]. Knot is tied with adequate tension to eliminate any obvious bleeding and to achieve complete hemostasis [Figure 1d]. In some cases, additional mattress sutures are needed to stop bleeding. This technique has now been tested effectively in three patients with the bleeding of posterior wall of vena cava without exposing the posterior wall. And more importantly, if this method failed to control the bleeding, the thymus gland tissues can be removed by cutting off the suture without doing any damage to the vessels. We believe the new technique described here is safe, effective, lower risk of infection (compared to artificial felt), and especially useful when the bleeding occurs after the cardiopulmonary bypass has been dismantled.
Acknowledgments Ye‑Qing Mao (Zhejiang University) is appreciated for drawing the topography.
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Figure 1: (a) Accidental bleeding on the posterior wall of vena cava during the procedure of vena cava cannulation; (b) Sutures passing through the interspace under the posterior wall with unilateral crossed thymus gland tissue; (c) Making the mattress suture; (d) The bleeding was stopped after ligation. Address for correspondence: Dr. Hai‑Ge Zhao, Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000, China E‑Mail: [email protected]
Access this article online Quick Response Code:
Website: www.cmj.org
DOI: 10.4103/0366-6999.154332
988
Received: 29-01-2015 Edited by: Xiu-Yuan Hao How to cite this article: Ni YM, Altangerel B, Xu HF, Zhao HG. A Trick to Control the Bleeding in Cardiovascular Surgery. Chin Med J 2015;128:988. Source of Support: Nil. Conflict of Interest: None declared.
Chinese Medical Journal ¦ April 5, 2015 ¦ Volume 128 ¦ Issue 7
A Trick to Control the Bleeding in Cardiovascular Surgery Yi‑Ming Ni1, Bold Altangerel2, Hong‑Fei Xu1, Hai‑Ge Zhao1 1
Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of the Zhejiang University, Hangzhou, Zhejiang 310000, China 2 Department of Thoracic Surgery, National Cancer Center, Bayanzurkh District, Ulaanbaatar, Mongolia
Key words: Bleeding; Thymus Gland; Vena Cava Cannulation
When accidental bleeding happens on the posterior wall of vena cava during the procedure of vena cava cannulation [Figure 1a], two pieces of thymus gland tissue around 2 cm × 1 cm were taken as the mattress tips, and these two pieces of tissue were put aside the bottom of vena cava, then use Prolene (Ethicon, Somerville, NJ, USA) to pass through the interspace under the posterior wall to make a mattress suture [Figure 1b and c]. Knot is tied with adequate tension to eliminate any obvious bleeding and to achieve complete hemostasis [Figure 1d]. In some cases, additional mattress sutures are needed to stop bleeding. This technique has now been tested effectively in three patients with the bleeding of posterior wall of vena cava without exposing the posterior wall. And more importantly, if this method failed to control the bleeding, the thymus gland tissues can be removed by cutting off the suture without doing any damage to the vessels. We believe the new technique described here is safe, effective, lower risk of infection (compared to artificial felt), and especially useful when the bleeding occurs after the cardiopulmonary bypass has been dismantled.
Acknowledgments Ye‑Qing Mao (Zhejiang University) is appreciated for drawing the topography.
a
b
c
d
Figure 1: (a) Accidental bleeding on the posterior wall of vena cava during the procedure of vena cava cannulation; (b) Sutures passing through the interspace under the posterior wall with unilateral crossed thymus gland tissue; (c) Making the mattress suture; (d) The bleeding was stopped after ligation. Address for correspondence: Dr. Hai‑Ge Zhao, Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang 310000, China E‑Mail: [email protected]
Access this article online Quick Response Code:
Website: www.cmj.org
DOI: 10.4103/0366-6999.154332
988
Received: 29-01-2015 Edited by: Xiu-Yuan Hao How to cite this article: Ni YM, Altangerel B, Xu HF, Zhao HG. A Trick to Control the Bleeding in Cardiovascular Surgery. Chin Med J 2015;128:988. Source of Support: Nil. Conflict of Interest: None declared.
Chinese Medical Journal ¦ April 5, 2015 ¦ Volume 128 ¦ Issue 7
