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

[Tea Acuff]

Yes surprisingly there was some duplicity (multiplicity?) to my thought. As usual I am to be corrected.
tea


----- Original Message ----
From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, July 10, 2007 1:33:02 AM
Subject: Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery


I suspect you mean adhesion. Bio Glue is a glue that bonds two 
surfaces together. Cohesion has many meanings, in the physical sense 
it relates to intermolecular attraction and that ain't what is 
happening in a VSD.

>I agree with all (both?) your assertions. However your query 
>neglects the consideration that not only is there centrifugal (ie 
>inward to outward force) with contraction, but there is lateral 
>strain and twisting motion inherent in (but not necessarily coherent 
>to) the outer walls and patch. Sometimes it is difficult to get to 
>normal tissue. For those of us with less than perfect suture 
>placement and tension, and perhaps a limited number of pledgets, the 
>glue provides the required cohesion.
>By the way you should look at the biology of the Cor Matrix patch. 
>It is not polyester. It is quite interesting. One should be aware 
>that I have a "confluence (so called conflict) of interest". After 
>all the reason we like to hear your opinions on valves and 
>pericardium is that you have worked with them for decades, not 
>because you are "objective" (ie disinterested in the results). 
>Caveat empetor.
>tea
>
>
>----- Original Message ----
>From: "Rwmfglycar at aol.com" <Rwmfglycar at aol.com>
>To: OpenHeart-L at lists.hsforum.com
>Sent: Sunday, July 8, 2007 10:08:14 PM
>Subject: Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery
>
>
>In a message dated 7/8/2007 7:31:48 P.M. Eastern Daylight Time, 
>Hgrmd at aol.com writes:
>Hal,
>Thye principle that we applied was to place the largest patch that we could 
>find space for over the defect with the idea that ventricular pressure would 
>drive the patch against the defect and that the sutures would be between 
>patch and normal uninfarcted tissue. We always used pericardium 
>because a) its 
>burst strength is by far in excess of the pressure it will meet; b) it is 
>impermeable and c) the host heals to it very quickly.
>It is not clear to me what glue and another layer of polyester adds to this 
>approach
>Bob
>
>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
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