[HSF] Image of the week Post BMV LV rupture

[Tea Acuff]

Could you send both picture and video? I seem to have lost them. What is B? MV? Blunt Motor vehicle?

tea


----- Original Message ----
From: psimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, October 19, 2007 12:35:51 PM
Subject: Re: [HSF] Image of the week Post BMV LV rupture


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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