Use of venous fistula technique for intraoperative cardiac hemorrhage.
We describe an innovative technique to control hemorrhage after right atrial wall reconstruction in a patient with primary angiosarcoma. At the time of surgery, the tumor was found to involve all of the free wall of the right atrium and a superficial layer of the right ventricle. A pericardial patch was used to reconstruct the right atrial wall; however, there was diffuse coagulopathy with bleeding from the anastomoses and remaining tumor. To tamponade the bleeding, a Dacron patch was sewn to the right edge of the pericardium, around the right ventricle and right coronary artery, but with little improvement in the bleeding. A type of Cabrol fistula was then formed with a tube graft from the Dacron patch to the left innominate vein. This acted as a conduit back into the venous system, with the blood taking the path of least resistance. Hemostasis was then achieved, allowing the patient to be taken to the intensive care unit.
Nielson
D H
DH
Lankenau Hospital and Medical Research Center, Wynnewood, Pennsylvania 19096.
Sutter
F P
FP
Goldman
S M
SM
D000328:Adult; D016063:Blood Loss, Surgical; D001807:Blood Vessel Prosthesis; D016121:Brachiocephalic Veins / Q000601:surgery; D005260:Female; D006325:Heart Atria; D006338:Heart Neoplasms / Q000601:surgery*; D006352:Heart Ventricles; D006394:Hemangiosarcoma / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D011093:Polyethylene Terephthalates; D019736:Prostheses and Implants
D011093:Polyethylene Terephthalates