[HSF] A case: cardiac rupture

Wed Oct 18 17:54:23 EDT 2006

There is a new material, mrdh (TM), from a company called Syvek  (email:
johnv at webmpt.com) which has just been released by the FDA for clinical
use. This so call dressing, is similar to a 4X4 gauze, containing some
form of polymer, that adheres to the surface of bleeding tissues. THIS
IS SIMPLY TOO GOOD TO BE TRUE!  And it is. If you have a knife wound
from the aorta, a lacerated  liver, or a bleeding infarction, and you
apply this material to the area (with active bleeding), within a minute
the bleeding will stop. I was involved in the evaluation of this
material, which is being used at our trauma center, and never thought
this was possible. Those who are dealing with major bleeding ought to
trial this material.

Tomas

-----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, October 18, 2006 4:25 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] A case: cardiac rupture

Roberto,
  Tough case.  I suspect the primary problem was MI with subsequent
rupture of the LV.  You were probably trying to close the perforation by
suturing already infarcted muscle.  With additional CPR and liquefaction
of infarcted myocardium, the rupture kept reopening.  Frustrating, sure.
However, I applaud you and your team's unrelenting efforts in trying to
save her.  A lot of docs would have given up a lot sooner.
Hal 

-----Original Message-----
From: battr at medizin.uni-leipzig.de
To: OpenHeart-L at lists.hsforum.com; Heart-L- at lists.hsforum.com
Sent: Wed, 18 Oct 2006 11:06 AM
Subject: [HSF] A case: cardiac rupture

Dear Members,

Woman born  1952, was  studied In a foreign Hospital  because of
haemopericardium of unknown origin. CT: No dissection, haemopericardium.
There she was  punctured and send then  to HZL.   In Leipzig she got ECG
,
almost normal, CKMB normal, troponin was not done, and went directly to
cath
lab: LAD 99% stenotic, RCA 2-3 stenosis 70%, CX 50%. She got another
punction for tamponade, unsuccessful. Then the interventionist, under
reanimation,   called me for inferior drainage. I did a  5 cm incision
and
drained it ( lot of clots and 200 blood). With good pressure, I send her
to
OR. During the transport, she was  again 2 times reanimated.  In OR, we
put
her on pump. The aorta was ok. I closed 3 bleeding sites. One at the
marginal angle of RV,  and two bleeding strongly between Diagonal and
obtuse
marginal branches. These were stitched with 4/0 Prolene with pledget.
Also
there was a haematoma in the region of the sulcus, at the region  of  AV
groove. I thought as diagnosis   1. status after heart reanimation or 2.
acute infarction. I added   2 vein bypasses   to LAD and PD. (no mammary
because of reanimation and sternal fracture). If it was an infarction,
why
there, the CX was only 50% stenosed!.  I added glue and tachosyl as for
a
coronary sinus rupture. 

After going out off bypass, came blood from the sutured zone, where the
pledgets were stitched, now the muscle looked a little disrupted. .
Again 20
minutes on bypass, I added 2 teflon felt strips sutured with 3/0 Prolene
as
it were an aneurysma. It Bleeded diffuse, again Bioglue, etc. I added an
IABP as she was long reanimated and got That suture.  Quick time was 7%.
I
left the chest open and with packing, she received everything to favour
coagulation, inclusive factor 7.  At night she was reoperated by Michael
Borger, he had to stitch again with Teflon, again packing. Bleeding
stopped
12 hours after. The ventricle had good contractions on echo. No more
bleeding. One day after (may be a decision  error) ,she was again
reoperated
with intention to close the chest. After taking out the gauzes she began
to
bleed again. We poured 3 pistols of bioglue and tabotamp and so on.
Bleeding
stopped and the chest was left open. At night the heart ruptured , she
was
carried gain to OR, and there  died there at 3.00 AM. 

Questions: experience from the members, what would have done different
those
with experience, etc.

Diagnosis: 1.
infarction->haemopericardium->puntions->tamponade->reanimation->cardiac
rupture, etc against    2. other cause of haemopericardium and the rest
is
iatrogenic.

Roberto 

_______________________________________________
OpenHeart-L mailing list

Send postings to:
 OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies
and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------
________________________________________________________________________
Check out the new AOL.  Most comprehensive set of free safety and
security tools, free access to millions of high-quality videos from
across the web, free AOL Mail and more.
_______________________________________________
OpenHeart-L mailing list

Send postings to:
 OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies
and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------