[HSF] (no subject)

[Nasser F. Abou'Seada]

Your fears just denoted how aware you were of the problem. a nice rationale
in a surgeon, so long as such fears are well prepared for .. whatever comes
after that is always good. such fears never anyway stopped you having the
appropriate approach within the appropriate time frame. I hope all young
surgeons can learn to fear the consequences of their dare - not saying
un-necessary -  manouvers....
your approach was very cautious .... teaching us a lot ....
IMHO we never bite the bullet when it comes to OTHERS lives .... but
approach with rationale, confidence, calculated risk and awareness of the
consequences and anticipated potential complications ....... like you have
done ...

Congratulations again Sir .....
I do raise my Hat .... !

NFA



On Feb 6, 2008 10:59 AM, <hgrmd at aol.com> wrote:

>
> 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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