[HSF] A case: cardiac rupture

[prasannasimha]

Give me a pseudo aneurysm compared to death any day !! At least the 
patient lives to fight another day.
Prasanna

Tea Acuff wrote:
> One wonders whether this patch, if it worked, would create a pseudoanuerysm that would have to be repaired later. I am sure, at the time, later sounds like both a lovely solution and problem. 
> I probably am jaded, but having seen many Herculean or heroic (humbling?) failures, I would propose that they be defined in their most simplistic form, that is, bad judgement. This in turn may eventually lead to the esteemed status of experience if one can be brutally honest to ones self. 
> tea
>
>
>
>
> ----- Original Message ----
> From: "Salerno, Tomas" <TSalerno at med.miami.edu>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thursday, October 19, 2006 8:20:42 AM
> Subject: RE: [HSF] A case: cardiac rupture
>
>
> Mrdh (TM) is a new marine polymer, that has the ability to stop any bleeding, especially active anastomotic leaks, rupture vessels, liver laceration and others. This might be invaluable for such cases. This product is too good to be true, if you see it in use.
>
> Tomas
>
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Dr. Roberto Battellini
> Sent: Thursday, October 19, 2006 9:16 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: AW: [HSF] A case: cardiac rupture
>
> Thanks, Bob, what makes me crazy ist hat we succeeded first attempt and then
> we thought we could close the chest and then, ...game over
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
> Rwmfglycar at aol.com
> Gesendet: Mittwoch, 18. Oktober 2006 16:59
> An: OpenHeart-L at lists.hsforum.com
> Betreff: Re: [HSF] A case: cardiac rupture
>
> Dear Roberto,
> The problem with myocardial rupture through an infarct is twofold:
> 1) the dead tissue is considerably wider than the hole
> 2) the coronaries are epicardial which for fear of making things worse
> stops 
> you from taking the wide deep sutures in good tissue that you need to  
> achieve a secure direct closure. 
> Compare this with closing a ruptured septum due to myocardial infarction.
> By 
> placing a very wide pericardial patch against the septum on the left  
> ventricular side and attaching it to good myocardium and allowing the
> ventricular 
> pressure to compress the patch against the hole you do not need to  rely on 
> shallow sutures in necrotic tissue. While the mortality remains high
> salvage is 
> not uncommon.
> The same applies to posterior left ventricular rupture after mitral valve  
> replacement. In my experience the success is achieved by leaving the outside
> of  
> the heart completely alone and going immediately to removing the prosthesis 
> and  repairing the endocardial rupture site with a wide patch of pericardium
> on 
> the  inside.
> That said, I have seen one success (patient out of hospital and  walking 
> around a few months after the event) achieved by arresting the  heart,
> gluing a 
> pericardial patch over  the site of the infarct  and a wide margin around
> it, 
> with  small epicardial sutures at the edge of  the patch, waiting for the
> glue 
> to set before allowing the ventricle to fill and  beat. IABP support,
> minimal 
> inotropy and keeping the afterload low  postop.
> Too bad Roberto; we have all had the nightmare of herculaean effort
> rewarded 
> ultimately by failure.
> Yours
> Bob
>     
>
>
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