The Pediatric Cardiac Surgery Inquest Report



Delay in the second operation

However, the operation did not take place on April 6. It was delayed for two weeks so that Vinay could recover from a viral infection. From Sheena Goyal's testimony it appears that Vinay was tested for this infection largely at her insistence on April 5.

That day I was very concerned, like my whole family was very concerned. Like he was going for the surgery and nobody even noticed that he had that cold and that could have serious infection. (Evidence, page 972)

According to her testimony, a female doctor in the PICU eventually ordered a number of tests that led to the postponement of surgery. The doctor she spoke with was Swartz. In her testimony Swartz said:

This is the perfect season for this particular virus which is called RSV, which is respiratory syncytial virus, which is not a friend to patients with congenital heart disease. And the concern is going in for-being on bypass with RSV is essentially lethal, which might also explain why his lungs were a bit leaky and why we were having trouble with ventilation. (Evidence, pages 15483-15484)

After discussing the matter with Sheena Goyal, Swartz ordered a new RSV test. (A previous one a few days earlier had come back negative.) Swartz then spoke with Odim and suggested that the operation be postponed. According to Swartz, Odim initially opposed this suggestion because he believed that it was necessary to repair the heart as soon as possible. In the morning, the RSV test results came back positive and the procedure was postponed.

In his testimony to this Inquest, Cornel commented on the prospect of re-operating 30 days after the initial operation.

It's just about the worst time to have to re-operate. The adhesions at this stage are kind of a bloody, gelatinous mess that glue the heart and its structures, its surrounding structures together, and, obscure the details of the anatomy.

Wherever you dissect to free the heart from the other structures bleeds-not a huge amount of bleeding, but it's all oozing all the time. It obscures where you want to work, makes it difficult to work. It makes accurate dissection very difficult.

It's, it really is a horrible time to have to go back. (Evidence, page 44,761)

Cornel also testified that he believed that redo operations, particularly the management of the adhesions that form following previous operations, are very difficult. He said the management of such adhesions is a skill that surgeons only develop over time.

You do hear or do see people say in the surgical literature that re-operation adds no risk. I think they are just being macho about it. I just don't believe that it adds no risk. It certainly adds huge trouble and time. And re-operating at a month, I think adds more risk than at, say, a year after surgery. (Evidence, page 44,763)

Odim disagreed. In his testimony he said that re-operating 30 days after the original operation was not necessarily the worst time. Odim said that the time range for having these difficulties with re-operations was between three weeks and two to three months after the first operation.

Frankly, Cornel's evidence is to be preferred to that of Odim on this point. Cornel was a surgeon of considerably more experience than Odim and was much more familiar with actual day to day issues than Odim was. This was the first time that Odim had had any experience with doing a redo 30 days after an initial repair on his own, and his comments suggest more bravado than experience. It also appears, however, that Vinay's condition at this point had left the surgical team with no other option.



Current Home - Table of Contents - Chapter 6 - Delay in the second operation
Next Pre-operative status
Previous Consent for the reoperation
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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