I Have Marfan Syndrome

Wednesday, 17 June 2009 06:41

I got a copy of the surgical report from my surgeon on Monday. I thought it was interesting, so I'm gonna post it here.

"PROCEDURE:

"The patient was brought into operating room and placed on the table in supine position. Generral endotracheal anesthesia induced without difficulty. Right radial arterial line, retro jugular, Swan-Ganz and Foley catheter were placed without complication. The patient was prepped and draped in the usual sterile fashion with Betadine solution. Prophylactic antibiotics were administered.

"The right common femoral artery and vein were isolated. A right anterior 44th interspace throacotomy was then created, and single lung ventilation was initiated. Inferior pulmonary ligament was mobilized up to the level of the inferior pulmonary vein, and the pericardium was then opened parallel and anterior to the phrenic nerve. Heparin was then given, cannulas were placed in the common femoral artery and vein, and cardiopulmonary bypass was initiated with flows of 2-4 liters per minute per meter squared, maintaining a mean arterial pressure of 80 mmHg. The pateint was cooled systemically to 25 degrees Celsius. Fibrillation ensued. The left atrium was opened longitudinally just anterior to the pulmonary veins. The mitral valve could be seen. The annulus was massively dilated, and he had extreme myxomatous disease. There was a ruptured chordae on P2, but the remainder of the valve appeared to be intact. I used a standard St. Jude valve size which was sized inside the annulus. The largest valve was 35 mm, and the annulus was at least 45 mm in diameter, and I feared that although he already had a mechanical valve in place, that this extreme downsizing would leave him with a significant perivalvular leak or chance to impinge upon the leaflets of the mechanical valve. Therefore, repair was chosen.

"Quadrangular resection was performed of P2. P1 and P3 were then reapproximated with 2 layers of 5-0 Prolene suture after performing a posterios annuloplasty. The valve was then seen to be competent at this time.

"A total of nine 2-0 Ethibond non pledgeted sutures were placed through the posterior annulus from commissure to commissure and brought sequentially through a 38 mm partial ring. Sutures were tied down sequentially. The valve was tested, found to be competent. The atrium was closed with 2 layers of running 3-0 Prolene suture. With the patient in Trendelenburng position, defibrillation was performed, normal sinus rhythm ensued.

"The patient was warmed to 36 degeres Celsius. An atrial pacing wire was placed. The patient was separated from cardiopulmonary bypass with the assistance of low dose sinus arrest. Post pump echo revealed no mitral insufficiency, no mitral stenosis and no SAM.

"Protamine sulfate was administered to reverse the heparin, cannulas removed, cannulation sites oversewn with 4-0 Prolene sutures. Two chest tubes were placed in the right pleural cavity, and the chest was closed with interrupted pericostal Vicryl sutures. Common femoral artery and vein were repaired with 6-0 Prolene suture and had excellent flow within them. Chest wall musculature was closed with PDS sutures, and the groin was closed in layers with PDS sutures. Skin was closed with running PDS suture. Steri-Strips were applied, sterile dressing was applied. The patient was brought to the 4 West intensive care unit in critical but stable condition."

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