Spontaneous Ear Hemorrhage during Cardiac Surgery

A 79-year-old patient who underwent mitral valve replacement experienced
prolonged elevated central venous pressure associated with poor venous
return during a cardiopulmonary bypass. After the procedure, the patient
was noted to have spontaneous bleeding from the left ear.
Otolaryngologic examination in the operating room showed no trauma in
the exterior auditory canal and suggested that the hemorrhage was
related to a superior vena cava syndrome and anticoagulation during the
cardiopulmonary bypass. Determinants and management considerations of
poor venous return, including maintenance of cerebral perfusion
pressure, are discussed.