Eosinophilic alveolitis.

445 shunts, there was no mention of the type of graft material or the technique of pre-clotting used for the ascending aortic graft itself. Certainly, massive bleeding has been described frequently in the early post-bypass period following ascending aortic aneurysm resection in many series and it has been seen at times by virtually all of us who have occasion to perform these procedures. Undouht-edly, the source of this bleeding is occasionally from proximal or distal sutures lines or from the anastomoses between the ascending aortic graft and the coronary orifices or vein grafts. However, it is usually the case that the majority of early post-bypass bleeding is not from the suture lines but rather through the interstices of the graft material itself. In the latter case, bleeding can he virtually eliminated by effective pre-clotting of the ascending aortic graft using a technique in which the graft material is soaked in albumin and then autoclaved This technique is entirely applicable to composite valve/graft conduits which use a mechanical valve. I have personally found this pre-clotting technique to he SO effective that virtually no bleeding has occurred after ascending aortic aneurysm replacement, even in cases where the aortic graft was not wrapped by aneurysm wall at all. I doubt very much that the authors used this pre-clotting technique for the patients described in their series. Had they done so, I cannot imagine that they would have had so many cases in which massive bleeding required the creation of left-to-right shunts. If meticulous care is taken with suture placement and if albumin/autoclave pre-clotting is used, it should be a rare case in which there is sufficient bleeding to require the shunt technique which the authors describe. brings up an extremely important point regarding the pre-clotting techniques used in ascending aortic grafting, which is quite pertinent to surgeons performing these procedures. Our failure to mention our pre-clotting technique in the methods portion ofour paper was an inadvertent omission. Dr. Griepp is a recognized expert in the field of thoracic aneurysm surgery and insures that our group incorporates state-of-the-art techniques and concepts in the conduct of these procedures. In fact, we have used the pre-clotting technique of soaking our low-porosity woven grafts with 50 ml of 25 percent albumin solution followed bb autoclave sealing at 270#{176}Ffor five minutes as described by Thurer et al (Circulation 1982; suppl 1; 143-46) in all of the patients in …