[HSF] Posterior Post-Infarction VSD, SAM, and other Misery

[Tea Acuff]

Perhaps it does in some respects I don't think that way (ie who recommended what). I think that the large endopatch supports the whole infarct. I tend to think of his procedure as the Pledget Procedure, not the Daggett Procedure. You have to use what is available, so I won't criticize further. I used only a few pledgets, maybe 4-6. I also think that the more pliable material is preferable.
tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, July 8, 2007 6:29:08 PM
Subject: Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery


Tea,
  I appreciate your contribution to this thread.  The outcome of  your 
patient was expected and no reflection on your technique.  As we all  know, these 
are desperately ill patients in deep cardiogenic shock.  The  best we can do is 
offer prompt surgery that doesn't later fall apart.  
  As for your technique, why did you attach the septal patch to the  
nonseptal side of the ventriculotomy?  Otherwise, from your description,  you employ a 
2 patch closure as originally described by Daggett.  The one  I'm describing 
is actually 3 patches, 2 for the septum (autologous pericardium  covered by a 
larger patch of Hemashield with Bioglue in between) and 1 for the  
ventriculotomy.  By using 2 patches over the septum, this provides a nice  space for the 
Bioglue to be injected without it being directly exposed to either  
ventricular cavity.  Use of the Embol-X cannula further protects from  Bioglue emboli.  
As best I can remember, I've used this technique on the  last 4 VSD's I've 
had, and they've all survived with no dehiscences.   This extremely small series 
is nothing to brag about, but it looks  promising.

Hal



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