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.