This is a first. Unnecessary complication following CABG… A colleague sent me this image… every time he tried to pull the Swann out, the patient would experience massive hypotension! @BaoGTran @Abedeanda @drraycleemd @AspiringCTS
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Luis J Castro MD
1,491 posts
Luis J Castro MD
@LuisCastroMD
Heart Surgery-MarinHealth, CA. Tips/Techniques to facilitate heart surgery. All my opinions based on personal experience. Yolopactli/ticitl
- Redo surg: ViV 2 yrs ago with Medtronic Evolute TAVR inside 4 yr old surgical prosthesis with leaflet perforation after endocarditis. Rapid progression to AS despite Dapt and Coumadin. Aortic root recon with Homograft @ovidiogarciav @tomcnguyen @BoYangMD @DVDaniels
- Another LAD endarterectomy. NSTEMI, EF25%, chronic 100% mid LAD obstruction. Mills instruments. With experience, 5-10 minutes … flew off bypass, 3 mcs Dopamine. Short video demonstrating technique @M_Pompeu_Sa_MD @BaoGTran @APolancoMD @nikhilnihil
00:00 - #CABG, when you must use SVG, make it beautiful! “Un-reverse”, cut valves, splice out obvious segments that may contribute to early failure. Not difficult. Patients have benefited w long term patency. @M_Pompeu_Sa_MD @CristianRosuMD @lindaschulteMD @GianTorre610 @BobbyYanagawa
00:00 - 81yo, Enterococcus TAVR (implanted 8 mo ago elsewhere) endocarditis & heart block w root abscess, severe AS/MR & infected erosion/incipient fistula➡️RA. TEE images to follow. @GilbertTangMD @DrMoritzWvB @tomcnguyen @GianTorre610 @LarsSvenssonMD @M_Pompeu_Sa_MD @AspiringCTS
- Part 1: VATS LAA AtriClip done by a master surgeon, Gan Dunnington. From skin incision to Clip▶️ 2:45 minutes! Do not try at home. @M_Pompeu_Sa_MD @BobbyYanagawa @ovidiogarciav @AllThingsAfib
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00:00 - 77yo Staph endocarditis S/P TAVR, DDD pacemaker 8 weeks ago. Failed 6 week IV Antibiotics, worsening CHF. AortoMitral Abscess with 4+MR, perivalv AI, transferred for operation. #TAVR #SAVR @ovidiogarciav @BoYangMD @AortaSurg
- Rheumatic mitral valve disease. Complete excision of Mitral apparatus to allow for 31-33 size mitral prostheses. @ovidiogarciav @BoYangMD @AortaSurg @M_Pompeu_Sa_MD @AspiringCTS @AskDrMarc
- Modified Manougian does not require incision into left atrium and does not interfere with "true" mitral leaflet. Adds >17mm to perimeter and allows 2-3 ⬆️valve sizes. Adds <20 min to clamp time. See you at STS San Antonio!
00:00 - Standard root enlargement patch cut from 34mm Hemashield tube graft. Easy to duplicate. Annulus size 19mm w surgical valve sizer. Upsized to 23mm with standard Manougian. BSA 1.6. Gradient 3mmHg. Adds 10 minutes to clamp time, & tremendous value. @AspiringCTS @M_Pompeu_Sa_MD
00:00 - 1/2 Reverse Saphenous vein technique for #CABG: Standard cannula placed on proximal/wider end of vein to permit naturally tapered distal end for coronary anastomosis. Connect to heparinized saline. Gentle pressure in syringe after Mills type valvulotome passed up vein lumen…
00:00 - Always impressed when I see angiogram with ALL patient grafts. LIMA-LAD, SVG-RCA, SVG-OM done 21 years ago. Performed by a retired Master Surgeon in 2001. Technique & experience matter. Patient, now 87, needs TAVR. @M_Pompeu_Sa_MD @BobbyYanagawa @ovidiogarciav @AspiringCTS
00:00 - Closing thin walled RIGHT atrium is tricky. Edge2edge creates everting closure which can bleed+needle hole bleeding. Take double bites near edges w running prolene➡️ inverts Suture line, more hemostatic & no needle hole bleeding. @lindaschulteMD @M_Pompeu_Sa_MD @drraycleemd
- Dehisced mitral ring. Somebody tried hard to downsize this annulus and create mitral stenosis. The LV and base of heart said “No you don’t!”… nature has a way of teaching lessons. @ovidiogarciav @Abedeanda @drraycleemd @FiedlerAmy @tomcnguyen @M_Pompeu_Sa_MD @AspiringCTS
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