[HSF] Todays complication !! and a HSF Guest

Fri Nov 3 07:34:16 EST 2006

High Rank Recommendoma Syndrome 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of venkataraman ravishankar
> Sent: Friday, November 03, 2006 2:25 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Todays complication !! and a HSF Guest
> 
> It happens quite often in our armed forces set up, 'high risk' groups are
doctors and
> their families followed by officers and their families based on their rank
structure !!
> Incidentally wifes are one rank higher than their husbands!
>   Talking about the stethescope episode, it's useful to keep it on the
open
> endotracheal tube immediately after a BT shunt, can hear the murmur on the
table.
>   Ravi shankar
> 
> prasannasimha <prasannasimha at gmail.com> wrote:
>   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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