[HSF] Todays complication !! and a HSF Guest

[Donald Ross]

It might be an interesting thread: telling stories of the disasters  
observed when visiting other surgeons, or in this case when being  
visited.
What happened to Jim Cox when I visited him when he was at Duke,  
however, could not be discussed on an open forum!
I have a lovely memory of watching Carpentier do repair long before  
tee was invented. He called for his sterile stethoscope and a nurse  
appeared with huge scissors to snip holes in his hood to get to his  
ears, then he handed me the stethoscope to hear the no-existent  
murmur. ( the gender neutral change room was also quite a novelty )
Don
On 03/11/2006, at 5:20 AM, prasannasimha wrote:

> Our own HSF's Chandrashekar Ramaih had come to my Hospital today  
> and for his treat I had kept a case for OMV/MVR = emaze with a  
> large LA body clot (huge one) and another case of rheumatic MR for   
> repair.
> It was so nice to meet another person from HSF. I must thank Dr  
> Levinson for starting this list that enabled people to meet across  
> the globe.
> (I have met Don Ross, Ben Bidstrup apart from our group from India  
> like Ravishankar and Anurag Garg whom  I meet in our national  
> conference yearly).
>
>
> As usual when a guest comes something has to go wrong. The OMV was  
> not good and I had to replace the valve  (after the LA thrombectomy  
> and an e maze). That was not so much a problem . (The valve was not  
> a great choice for OMV but we anted to give her a chance)
> When I released the cross clamp , I was a bit worried about some  
> blood welling up laterally and had a peep and saw some bleeding  
> there and lo behold I saw a hole in the Left superior pulmonary vein.
> In retrospect, this case had required extraction of clots from the  
> pulmonary veins and Chand had commented at the beginning when I was  
> delamellating the clot that the LA was very thin and I had agreed .  
> I had removed the clot etc etc (very large clot _ I am not sure If  
> Chand had photographed it) any way I think that while I was sucking  
> out and washing the LA and the Pulmonary veins I must have pocked  
> the PV with a sucker and perforated it. The tear started to extend  
> towards the LA body when I was trying to evaluate it .It required a  
> reapplication of the cross clamp, a short period of circ arrest to  
> allow good visualization (and as usual when a guest comes - the  
> Heating Cooling unit had to promptly conk off and the heart would  
> not easily stop !!) Any way after a few pledgetted 5/0 sutures and  
> a bit of prayers and a bit of glue the bleeding was controlled and  
> we have had an uneventful post op so far.
> I have now done 56 (I got the count wrong as last week I had done  
> another body clot) giant LA body clots with emaze and never  
> encountered this problem so far !!
> Any other suggestions ?
> At least the second repair which required some amount of  
> commissurotomy ,posterobasal chordal release, Anterior chordal  
> shortening and an annuloplasty was uneventful. It would have been  
> tragic if two attempts at conservative mitral valve surgery had  
> ended in a replacement - especially in front of a visitor :-) !!
> Question - how would you manage friable papery tearing tissues ?  
> especially in that position.
> I used a DPRS suture to flip the heart and called for assistance to  
> gently retract the heart. I ran an initial 5/0 and then placed  
> pericardial pledgetted sutures serially at residual bleeding  
> points.  I then placed some glue over it.
> My other possible plans were to suture over the whole area a piece  
> of pericardium or use the LA appendage as a bung of tissue to cork  
> the hole.
> Incidentally any one else who wants to come to my institute for a  
> visit - you are all welcome !!
> Chandrashekar  will be giving a lecture on VAD's and Robotics to us  
> on Saturday and we are looking forward to it.
>
> Prasanna
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