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

Fri Nov 3 07:42:09 EST 2006

Totally agree .....
can start subheading a new chapter ... 
incidentally ..... any explanations ??? Tea ?

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of psimha
> Sent: Thursday, November 02, 2006 8:06 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] !! HSF Guest - Recommendoma Syndrome ..
> 
> 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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