[HSF] Image of the week Post BMV LV rupture

[Nasser F. Abou'Seada]

Thank you Dr Sukumar for your rich comment. that reminds me of the dictum on
"Hamilton Bailey's Emergency Surgery" : Emergencies cease to exist whenever
they are well prepared for.

NFA


On 10/20/07, Mehta Sukumar <sukumarhmehta at yahoo.com> wrote:
>
> Prasanna,
> CMV has been my favourite operation. I am sure, so is the case with all
> those who were trained at King Edward Memorial Hospital, Mumbai in the
> pre-balloon era. But of late, closed and open mitral commissurotomy has
> disappeared from my operation list and I regret that.
> A few years back, to be precise, in 1998, I was referred a case of "atrial
> stitch" during BMV and I took the patient for exploration through a left
> thoracotomy. I had difficulty in reaching the puncture site and had to
> extend the incision across the lower part of LIMA to reach and repair the
> IVC-RA junction. In the next "atrial stitch" case, I explored through
> midline and used short cardopulmonary bypass. That was in the year 2000. A
> couple of subsequent cases, I repaired off pump. I have also repaired off
> pump, a couple of right ventricular injuries that occured in the cathlab,
> with the cardiologist trying to drain tamponade in a collapsing patient in a
> hurry and managing to pass the guide wire, dilator and sheath all the way in
> to the cardiac chamber. I thought of pump in your case as a life support
> system and not as a device to facilitate exposure.
> It's not easy to shift the heart lung machine in my set up too, though the
> OR and the cathlab are on the same floor. And I have never done that. But my
> perfusionists are ready with a set of percutaneous canulas and are willing
> to take up the challenge of setting up bypass in the cathlab if required. If
> at all I happen to put the cathlab patient on pump, I would be more
> comfortable if I shift him to OR and complete the remaining part of the
> treatment in the OR. Everyone of us has shifted patients to and from OR with
> balloon pumps. I feel, shifting the patient to OR with a couple of
> percutaneous canulas and one or two pump consoles ( operated on battery back
> up ) would not be much more difficult. It would be worth the trouble.
> So, it would be basically, only the OR team (and not the cathlab ream)
> which will run the show from the moment the case is referred. Cardiologist
> would be helpful in placing percutaneous canulas in emergency. By shifting
> the patient to OR thereafter, I would overcome the need for setting up a
> makeshift OR in the cathlab.
> I have not run practice or training sessions but have had several
> discussions with perfusionists on how well and how fast they would be able
> establish a partial cardiopulmonary bypass in cathlab. And to my
> cardiologist colleagues, I have always said, "refer the patient early, the
> moment you feel that something has gone wrong, as even a few minutes are
> precious".
> I know, there must be better ways to practice the emergency drill and
> would like to know your training methods.
> Sukumar.
>
>
> __________________________________________________
> Do You Yahoo!?
> Tired of spam?  Yahoo! Mail has the best spam protection around
> http://mail.yahoo.com
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>