[HSF] Image of the week Post BMV LV rupture

[Nasser F. Abou'Seada]

Magnificent Experience Prasanna
you must have done it many times to handle it like that.
my little queries:

- did you actually use the commercial CYANOACRYLATE glue available in the
shops ? or what else did you use ? how did you apply that ? what about the
sterilization of the external packaging container ? any problems with your
latex gloves ? any other precautions to be taken care of ?

- applying the purse string suture, were you not woried about "strangulation
of the myocardium" .. the least to consider then, but what did you do to
prevent any future problems from that ???

- how did you repair the other tears to the IVC- RA-LA ????...

- Just a little query.... why did you opt for a median sternotomy ? .. not a
left anterolateral thoracotomy ..... I say that considering the "reflex"
pattern of behaviour that an experienced surgeon at CMV / TVMC.... might get
..... did you consider any variables when making your fraction of a second
decision ???

- I agree with you, CPB would not have come to the mind of a CMV experienced
surgeon .... may be would have asked for it later should it have not worked
out ...

the Video did not pass ..... the photo is great .... but less than
satisfactory in describing such case ..... please try your best to send the
video ....

CONGRATULATIONS ....  for you, the patient .... AND the interventional
Cardiologist ... !!

NFA

On 10/19/07, psimha <prasannasimha at gmail.com> wrote:

> Things moved so fast and I did not have a free heart lung machine at the
> time though that would have probably have made it less stressful (or
> would it ?). Anyway  one of my junior colleagues opined to me at the end
> that since I was trained in the CMV days and was used to handling the LV
> apex probably using CPB would not have come first to my mind. Anyway if
> things had not worked I would have considered CPB  but if things were so
> mishmash then I probably would still have to use the glue patch  and
> keep the  patient on CPB to keep the area dry to allow the  glue to
> act.  Anyway things  were done quickly - direct suture failed - larger
> needle - failed - pericardial patch failed - largest silk suture on
> largest needle pursestring wide around the whole of the LV and tie -
> viola - worked. Resuscitation and waited to see if it held and glue was
> bought by a cardiology resident from a general shop across the road (no
> glue in house) and it stuck well. Closed and resuscitation continued
> and chest closed  In the meanwhile my case that was induced in the OR
> was waiting !!). I know one thing. If I had procrastinated and insisted
> on moving a HLM precious  time would have been lost. We rarely use CPB
> for cardiac trauma so I am not so sure if it is really necessary .
> Till now we have managed most BMV tears without CPB. I have used at
> times a cardiotomy reservoir and a Ryles tube in the RA to allow suction
> bypass with the cardiotomy reservoir acting like a cell saver and once
> used temporary inflow occlusion. One of my colleaguses has used CPB.
> The only time I have used CPB was to repair or replace a torn mitral
> valve in low output and cardiogenic shock due to acute MR.
> Prasanna
> Mehta Sukumar wrote:
> > Prasanna,
> >   Congrats.
> >   Did you think of cardiopulmonary bypass support at any stage treating
> this emergency?
> >   Sukumar.
> >
> >
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