[HSF] Image of the week Post BMV LV rupture

[Ani Anyanwu]

When you use the word many (as in many of these patients do well) it gets me worried about the skills of the cardiologists you work with. Surely if you are seeing 'many' patients in this condition, your cardiologists or yourselves are doing something wrong?
 
Ani
 



> Date: Sat, 20 Oct 2007 13:18:26 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Image of the week Post BMV LV rupture> CC: > > We have been seeing more and more cases like these. Our EP guys (who are> great) have a huge extraction practice and inherrent with that procedure> comes the occasional misadventure. While sometime the decision to operate> is obvious - often it is not as we see sometimes small perforations often> seal on there own (think of all of those temporary atrial wires that get> pulled on the floor) - sometimes they dont. Unfortunately, these patients> are typically disasters (why else would they be getting the systems> implanted/explanted???) and emergency surgery is always an adventure.> > Typically for a variety of reasons we put these patients on fem/fem byass> which then gives everyone, especially the patient, time to catch their> breath. We will then perform a TEE to confirm the diagnosis. Even those> 1+1 usually equals 2, we have been "burned" a few times by opening chests in> the OR for tamponade and not finding it nor a hole.> > Surprisingly, many of these patients - even with CPR in progress - tend to> do quite well.> > > -michael> > > On 10/20/07, psimha <prasannasimha at gmail.com> wrote:> >> > While I was ready to put the incision the cardiologist was> > autotransfusing and the pressure went up a bit and he said can we see> > for some more time (I was not convinced seeing the rapidity of fluid> > withdrawal), In the next few seconds the irritated anesthesiologist told> > me the pressure is crashing again so I solved the problem once and for> > all by placing a skin incision (The sternal saw was yet to come)- this> > sort of made the decision complete - no vacillating when you have a long> > incision on the chest !! :-) Sometimes being proactive can help the> > decision pathway !! ;-) The gush of blood to a nonsurgeon on opening> > the chest was a sufficient to convince the cardiologist that we were on> > the right path.> > Prasanna> > Mehta Sukumar wrote:> > > Nasser,> > > Couldn't agree with you more.> > > Cardiologist would be reluctant to submit the patient for emergency> > exploration as long as the patient maintains some hemodynamics even with> > high dose of inotropic agents. And that's the reason for the delay in> > referral in most cases.But my anaesthetist tells me that patients received> > late are invariably severely acidotic by that time. A timely referral makes> > life so much easy for the OR team.> > > 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> > > -----------------------------------------> > >> > >> > >> >> > _______________________________________________> > 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> > -----------------------------------------> >> _______________________________________________> 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> -----------------------------------------
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