[HSF] Right Sinus of Valsalva-Right Atrial Fistula

[A]

Good job not only that but honesty in reporting what went on. Way to go 

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Hgrmd at aol.com
Sent: Wednesday, November 08, 2006 3:28 AM
To: OpenHeart-L at lists.hsforum.com
Subject: [HSF] Right Sinus of Valsalva-Right Atrial Fistula

Dear Members,
  Again, thanks to those who advised me on how to handle this  case.  
Yesterday, I did it.  It was actually no big deal.  On  TEE, you could
easily see 
that the fistula went from the right sinus, near the  right-noncoronary 
commissure, to the right atrium.  There was a classic  "windsock" in the
right atrium.  
There were no associated valvular  abnormalities, and the coronaries were 
clean by angio.  The hard part was  that the patient had had a previous 
thymectomy for myasthenia.  When I  opened the bottom end of the sternotomy
with an 
oscillating saw, I noticed some  dark blood.  Fortunately, I promptly
decided to 
femorally cannulate and go  on CPB.  Thank God I did.  The pericardium was 
plastered to the  posterior sternal table and was opened with the saw.  In 
addition, I made a  10 by 20 mm rent in the confluence of the innominate
veins which 
were also  plastered to the sternum.  Because I was on CPB, it was no big 
deal.   I just grabbed some autologous pericardium and patched the hole.
Imagine 
 if I hadn't been on CPB?
   I pleged retrograde and then opened the right atrium.  I  cut the
windsock 
flush with the atrium.  It was right at the antero septal  commissure.  I 
then closed it primarily with 2 rows of 4-0 Prolene.   The postop TEE was
perfect 
and she did well.  I haven't checked to see if  she's extubated as yet.  I 
hope the myasthenia doesn't flare.
Hal
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