[HSF] !! HSF Guest - Recommendoma Syndrome ..

Fri Nov 3 06:36:01 EST 2006

That's a slightly different classification -  We call it the "VIP 
syndrome" !! though recommendoma could be the general heading (like a 
genus) and the individual types could be a subclassification like species !!
Prasanna
Nasser F. Abou'Seada wrote:
> Dear Prasanna .....
> Welcome to the club ..!!
> we have encountered this same situation .... also when a patient is "known"
> to some staff ... or being recommended by someone ..... a Syndrome called
> RECOMMENDOMA 
> ... from the word Recommend ... + suffix "-oma" ..... in its malignant
> meaning ..... 
> hahaha ...
> it is NOT related to the Personality of the visitor .... nor the
> recommending staff .... just the only variable of someone being recommended
> ... or some patient being "reserved" for a "show"  ....
> Sometimes .... when performing a straightforward operation ..... and
> something stupid goes wrong .... of no explanation .... I ask my assistants
> .... "you ... any one recommending this patient ?" .... and to my surprise
> ... there has always been someone .....  !!!
> Welcome to the Club .... 
> may be we should put that in a special chapter in your Wiki .... 
>
> NFA
>
>   
>> -----Original Message-----
>> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
>> bounces at lists.hsforum.com] On Behalf Of prasannasimha
>> Sent: Thursday, November 02, 2006 1:21 PM
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: [HSF] Todays complication !! and a HSF Guest
>>
>> 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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