[HSF] (no subject)

[hgrmd at aol.com]

Dear Nasser,

? Thanks for your words.? I only dissected out the anterior wall of the SVC.? Going around it would have been a dangerous hassle.? The incision for the atriotomy extended about 4-5 cm past the point of obstruction at the SVC-RA junction.? The clot was initially removed with Russian forceps and the cell saver sucker.? I then passed the Fogarty a few times, making sure that it went up towards the right IJ as well as the left turn for the innominate vein.? Torrential inflow was then established.? I then advanced the femoral venous cannula until the tip was well into the SVC.? This took care of most of the bleeding.? The patch? angioplasty was then carried out.? Overall, it wasn't nearly as bad as I had feared.



Hal


-----Original Message-----
From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 6 Feb 2008 7:11 am
Subject: Re: [HSF] (no subject)




Dear Hal
Congratulations for the patient .... and for you ....
did you have to dissect the SVC upwards towards the Innominate ..or not at
all ??  ???
how did you remove the clot ??? ......... suction then Fogarty ?? ..... or
no suction ???
How far did you introduce the Fogarty ?
Blood loss in suction ?? ...... machine sucker ? or external sucker ?
I guess the pacing wires imposed no significant hassle ...!!!!!
keeping on Coumadin .... ?? ..... for how long ??
Congratulations Sir ...
for the Operation, for the results ...... and above all ... for the decision
...

NFA


On Feb 6, 2008 5:20 AM, <hgrmd at aol.com> wrote:

> Dear Members,
> ? Two days ago, I reoperated on the gentleman with the stenotic and
> thrombosed SVC.? I'm glad I did.? I femorally cannulated and went on pump
> prior to splitting the chest (he was 3 weeks postop).? I only dissected the
> right atrium.? The adhesions were torture.? The tip of the femoral cannula
> was advanced only into the IVC.? No effort was made to control either cava.?
> The heart stayed warm and beating.? A right atriotomy was made and extended
> across the RA-SVC junction.? It was tightly stenotic.? A large amount of
> clot was retrieved with a 6mm Fogarty.? A large patch of bovine pericardium
> was placed.? The whole operation took less than 3 hours.? Yesterday, it was
> evident that his facial and forearm edema were markedly improved.? He's
> already on Lovenox and Coumadin.
>
> Hal
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