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Surgical Reminiscence
October 2000

Serendipity Salvages Disaster

Arch Surg. 2000;135(10):1232. doi:10.1001/archsurg.135.10.1232

CONTRARY to traditional thought, serendipity may play a more important role in clinical and scientific discovery than lengthy investigative research. Similarly, our profession turns out to be fickle and unpredictable in its acceptance of new ideas. Such was my accidental experience with a modality that has salvaged a number of potentially disastrous situations.

In the late 1950s and early 1960s, open heart surgery was in its dramatic and hazardous infancy, and the accepted approach to a stenosed mitral valve was by "blind" fracture with a finger introduced through the atrial appendage. It was also true that cardiac catheterization was reserved for resolving complex undiagnosed conditions. Thus, when I was referred a patient with symptoms and a murmur that were classic for mitral stenosis, there was no hesitation about scheduling her for closed valvotomy through the left chest. When I explored the left atrium with my finger, I was surprised and dismayed to discover a normal mitral valve that was being partially obstructed by a firm tumor the size of a small hen's egg. To remove it without benefit of extracorporeal circulation and an arrested heart would be impossible. Thus, I recognized the necessity of closing her up and returning at a later date with preparations for cardiopulmonary bypass. (In those days the "pump" required 14 units of fresh heparinized blood and lengthy preparation, which could not be accomplished while we waited.) Thinking it would be useful to identify the site of the tumor pedicle to facilitate the secondary approach, I elected to explore the atrial cavity, only to create a disaster. The tumor became detached and free floating in the atrium so as to cause a total obstruction of the valve whenever it was allowed freedom to move. Thus, my deflecting finger was essential to the patient's survival.

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