[HSF] Todays complication !! and a HSF Guest

[Nasser F. Abou'Seada]

you mean Hal  .... and Bill Clinton ... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Saturday, November 04, 2006 12:02 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Todays complication !! and a HSF Guest
> 
> 
> Tea, I spent some time trying to understand the Arkansas thing. The only
> people I know from Arkansas are Bill Clinton and Hal
> Prasanna
> Tea Acuff wrote:
> > Prasanna,
> >  Are you sure you are not from Arkansas?
> > Tea
> >
> >
> > ----- Original Message ----
> > From: prasannasimha <prasannasimha at gmail.com>
> > To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
> > Sent: Thursday, November 2, 2006 12:20:34 PM
> > 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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