Delayed thoracic wall bleeding after minimally invasive mitral valve repair

Abstract

The first case of late thoracic wall bleeding after minimally invasive mitral valve repair treated by endovascular therapy is reported. A 55-year-old woman underwent mitral valve repair and tricuspid annuloplasty through a mini-thoracotomy approach. Her postoperative course was uneventful until she had anemia one week after the surgery. Contrast-enhanced computed tomography showed right hemothorax due to bleeding from a branch of the right lateral thoracic artery. Endovascular coil embolization and gelatin sponge injection were performed. The patient was discharged without any complications on postoperative day 20.

A case of delayed bleeding of the chest wall after VATS treated with transcatheter arterial embolization

“…Chest wall bleeding may occur due to blunt trauma [ 1 ] and after thoracentesis or insertion of a chest drainage tube [ 2–5 ]. Some cases only develop hematomas on the chest wall, while others develop hemothorax [ 6 ]. However, delayed bleeding of the chest wall after thoracic surgery is rare.…”

“…However, delayed bleeding of the chest wall after thoracic surgery is rare. There has been a report of a complication after valvular heart surgery with small thoracotomy [ 6 ], but complications after lung cancer surgery or thoracoscopic surgery have not been described. The lateral thoracic artery is a branch from the axillary artery that descends the chest wall and enters the serratus anterior muscle.…”

“…Regarding the timing of delayed chest wall bleeding, Kamada et al. [ 6 ] found that hemothorax occurred 7 days after thoracic surgery, and Misthos et al . [ 12 ] reported a time from injury to onset of 2–14 days (mean 7 days) in 52 patients with delayed post-traumatic hemothorax.…”

“…As a method for hemostasis, we chose gauze compression for the initial postoperative bleeding, but this was insufficient and rebleeding occurred 17 days after the operation. Other treatments include hemostasis by endovascular intervention [ 6 , 13–15 ] and surgical hemostasis. In this case, we chose endovascular treatment, since this is less invasive than reoperation, the bleeding site was identifiable on angiography, and risks of general anesthesia, wound infection and lung injury in reopening surgery were avoided.…”