CASE 12—2014Inferior Vena Cava Compression by Retroperitoneal Hematoma During Cardiopulmonary Bypass

Abstract

From the *Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; †Division of Cardiac Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; ‡Division of Cardiothoracic Surgery, Department of Surgery, Aristotle University, Thessaloniki, Greece; §Division of Cardiac Surgery, Department of Surgery Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Address reprint requests to John G. Augoustides MD, FASE, FAHA, Anesthesiology and Critical Care, 680 Dulles, HUP, 3400 Spruce Street, Philadelphia, PA 19104-4283. E-mail: yiandoc@hotmail.com © 2014 Elsevier Inc. All rights reserved. 1053-0770/2602-0033$36.00/0 http://dx.doi.org/10.1053/j.jvca.2013.10.020 CARDIOPULMONARY BYPASS (CPB) first was applied successfully in cardiac surgery by John H. Gibbon in 1953. Since that clinical milestone more than 60 years ago, CPB has evolved into a mainstream technique in contemporary cardiac surgery to facilitate openand closed-chamber procedures of all types, including specialized perfusion approaches such as deep hypothermic circulatory arrest. The safe conduct of CPB requires a vigilant and experienced team approach to minimize serious errors and to solve critical events when they occur. This conference presents a challenging case of major retroperitoneal hemorrhage that presented during CPB. The successful detection and management of this rare but serious complication is outlined, highlighting the principles of a team approach, vigilance, and creative applications of transesophageal echocardiography. The case conference begins with a description and discussion of the case, followed by 2 expert commentaries, the first from the cardiac surgeon’s perspective and the second from the cardiac anesthesiologist’s perspective.