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Ann Thorac Surg 1999;68:1889
© 1999 The Society of Thoracic Surgeons

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Correspondence

Shunt control of ascending aortic bleeding

^a Cardiovascular & Thoracic Surgeons, Inc, 2123 Auburn Ave, #401, Cincinnati, OH 45219, USA

e-mail: jflege{at}cardiosurgeons.com

To the Editor

Mancini and Cush [1] described control of bleeding from the aortic root by shunting into the right atrium.

During the past 30 years, I have encountered serious bleeding from the aortic root after aortic valve replacement on several occasions. This has resulted from injudicious removal of calcium posteriorly adjacent to the mitral annulus, or from difficulty in closing the end of the aortotomy deep in the noncoronary sinus after implantation of a prosthetic valve that was too large. As a first maneuver, I have used sutures across the bleeding point passed through a piece of Teflon (L.R. Bard, Tempe, AZ) felt, which often did not control the bleeding. In the early years, I then opened the aorta and repaired the defect from the inside. This often involved removing the prosthetic valve and replacing it, taking a lot of time and no doubt contributing significantly to morbidity and mortality. It occurred to me that if this bleeding, from an area already covered by felt, could be shunted into an atrium, then clotting would stop it eventually. In the last several cases encountered, I have used this shunting technique successfully. When the bleeding is posterior, at the junction of the aorta and left ventricular outflow track, an incision is made in the roof of the left atrium near and parallel to the base of the aorta. The superior edge of this incision is sutured to the aorta, just distal to the site of bleeding. When the bleeding is from the depths of the noncoronary sinus, an incision is made in the right atrium adjacent to the bleeding point, and the anterior edge of this incision sutured to the aorta, anterior to the site of bleeding. In every case, this has been successful in controlling the bleeding, and no patient has had a residual aortoatrial fistula.

References

1. Mancini M.C., Cush E.M. Shunt control of bleeding after homograft replacement of the ascending aorta. Ann Thorac Surg 1999;67:1162-1163.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John B. Flege, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Flege, J. B. Search for Related Content PubMed Articles by Flege, J. B., Jr