There is no doubt that I need this damn blog more than you,
As I texted to my wife tonoc: Frack, frack,frack!, but not exactly with that spelling.
Dateline Oct 12th, 2009 Monday 7am,
We arrived early at the Cabral hospital to set up and do 2 cases today, Both Double valve replacements on young women. 
The women’s bathroom on the ground floor had overflown and flooded the entire entryway…..bad omen.
Dr Crouch had the Hot Seat and had to do the first case of the mission, A lovely 34 yo singer with severe aortic stenosis and mitral stenosis. everyone hovered as he and his team pulled off a beautiful double valve replacement, except for when the ventilator wouldn’t work for about 5min but Wil Szerenyi finally figured it out while Dr Bandranko bagged the patient.
Dr Crouch’s case went flawlessly and we were all very excited!
The Patients and their families donate “whole blood” that we give intra-operatively as needed. Here you can see dr Juan carrying this patients stash of blood into the OR
and Dr Rome’, both cardiology residents who help us all day long interpreting and navigating the hospital. We could not survive without them.
Well now it was my turn at bat. I went with Rome’ up to the ward to meet my patient again and bring here to the OR suite.
This 38 yo Woman, mother of 2 also had mitral and aortic valvular disease and a weakening heart. we all literally walked down to the OR, she was in her best night gown and high heels.
We were all nervous, but as she entered the OR room Wil Szerenyi gave her a big hug and we all laughed. Nothing moves fast down there, especially the elevators. we heard that Dr Crouch’s case now done was awaiting elevator repair to get up to the 6th floor. Finally the team had to have a hospital worker Hand Crank the elevator up and there was still a 1-2 foot mismatch from the elevator to the floor.
Wil got his lines in and triple checked his vent and off to sleep we went around 11am to perform our double valve replacement. Both valves were thickened and stiff, the mitral valve had the classic “fish mouth” appearance. Her heart was very hypertrophic(thickened) from years of overwork. Everything was going great until we were about to come off the heart lung machine. Wil started looking with the Echo probe and could not clearly see both mitral valve leaflets moving???
Sometimes the angle of the valve and the position of the probe can make it be difficult to see the correct plane of the valve. I was concerned that perhaps some of the old valvular tissue may be trapped or blocking a leaflet. We had Dr Crouch, Dr pascotto and dr Bandranko all look at the echo, and no one was sure.
It is always hard on the heart to re-arrest it, but clearly we needed to know. We then stopped the heart again and opened the chamber to look at the new Mechanical Mitral valve……nothing, the leaflets appeared to move unobstructed. I could not find any abnormal tissue or lesion? We then rotated the valve into a different plane just in case there was a functional problem once the heart was full or it was a visualization issue of the Echo Probe. We came off the heart lung machine and both valves looked fine, but her straining heart had been pushed too far…. Five hours later after mulitple whole blood transfusions, Heart drugs and lots of “tincture of time” we headed to the hand crank elevator, praying she would continue to improve!
Everyone from Dr Crouch’s team including himself had stayed all day long to help, it was very appreciated.
We have Intra aortic ballon pump capability but Dr Bob suggested that if we could get by without it, it would be much easier to transport, so we did some recovery in the OR.
Finally it was time and we closed the chest.
Dr Juan called the elevator boys to warn them of our imminent arrival.
The resident Shayenne and I explained to her family the serious but hopeful situation and headed to the ICU.
Our Top notch ICU team of Shari, Laurie, Betsy and Chris swarmed all over our patient as we arrived. She had been stable in transport and Wil had weaned down the Epi quite a bit, an excellent sign.
Joe and I snoozed on spare ICU beds while Laurie and Shari got her fully settled.
Fortunately she awoke and moved everything, Dr Crouch’s Patient was next store sitting up in bed looking like she’d just had a manicure!
The team headed to a well deserved dinner with Joan and bob Pascotto, while Joe and I kept moral support for our ICU nurse Shari and Laurie. The heart drug primacor that helped get her out of the OR was running low. thats all we had for her. So we cut the dose to one quarter so that it would last the noc. About 11pm Dr Bob sent the shuttle driver back to see if we could leave. Our patient was doing well, still intubated and on EPI, Dobuta and Primacor(what was left). The 2 Cardiology fellows would watch her so we could get some rest for tomorrow.
Orginally I was going to do an ASD Atrial septal defect repair case, Usually one of the more easy straight forward heart surgeries (sounded great to me) but we asked for a right heart cath because she had a “Snow man “appearance to her Xray and her echo at conference did not show the limits to her heart defect(we were concerned she might have PAPVR, partial anaomalous pulmonary venous return). The Residents said she had a cath done today preop by Dr Lopez and that it did show some possible Pulmonary venous abnormalities and that she also had a coronary fistula and arrested several times after the cath! Thank God we delayed her and we will do my friday Mitral valve replacement case tomorrow instead.
Our entire team did an awesome job of getting two difficult cases done today and once again I am very proud and humbled to be working with these people.
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