[HSF] Todays complication !! and a HSF Guest

[prasannasimha]

Don, I used to do that (the stethoscope thing) I used to also 
auscultate  also keeping the stethescope head over the ET tube. 
Basically this was all balderdash in retrospect.
Prasanna
Donald Ross wrote:
> 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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