The Pediatric Cardiac Surgery Inquest Report



The operation-November 1

On Tuesday November 1, Ashton underwent:

  • a single-patch repair of the complete atrioventricular canal defect;
  • division of the anterior bridging leaflets, with re-suspension, of the mitral and tricuspid components, to the pericardial patch (or refashioning of the existing components of the mitral and tricuspid valves, using material from the pericardium);
  • Reed annuloplasty of the mitral valve (or repair of the opening of the mitral valve);
  • closure of the mitral valve cleft;
  • pulmonary valvotomy (or enlargement of the pulmonary valve opening);
  • excision of the extensive parietal muscle bundles within the right ventricle; and
  • ligation of the patent ductus arteriosus.

Ashton Feakes - pre-operative heart
Ashton Feakes - pre-operative heart

Diagram 8.6 Ashton Feakes - post-operative heart
Diagram 8.6 Ashton Feakes - post-operative heart
1 - Single pericardial patch of atrioventricular canal defect
2 - Partial excision of the extensive parietal muscle bundles
within the right ventricle
3 - Resuspended tricuspid valve
4 - Ligated ductus arteriosus
5 - Pulmonary valvotomy (or enlargement
of the pulmonary valve opening)
6 - Resuspended mitral valve (with subsequent dehiscence)

Compare pre- and post-operative diagrams side by side


The operating team is set out in the accompanying chart.

TABLE 8.5: Persons involved in the operation on Ashton Feakes, November 1, 1994
OR team member   Persons involved
Surgeon J. Odim
Surgical assistant B.J. Hancock
Anaesthetists H. Reimer, J. Doer (resident)
Scrub nurses C. Youngson, C. McGilton
Circulating nurses B. Zulak, C. Weber, K. Cox
Perfusionists M. Maas, D. Smith

The myocardial protection used was moderate hypothermia and intermittent cold blood cardioplegia.

TABLE 8.6: Length of phases of the operation on Ashton Feakes, November 1, 1994
Phase of the operation   Time taken
Induction 1 hour 47 minutes
Bypass 3 hours 21 minutes
Aortic cross-clamp 1 hour 57 minutes
Total surgical time 6 hours 20 minutes
Total operating-room time 8 hours 22 minutes

Odim testified that in his opinion, the repair in Ashton's case went very well. The other participants in the operation raised no issues about this procedure. However, Soder said that a procedure of this length would give him some anxiety.

During surgery Ashton experienced problems with heart block that continued during his post-operative treatment. He had third-degree heart block during the closure of his chest, which required cardiac pacing.

Aside from the fact that withdrawal from bypass required substantial doses of inotropes, Cornel concluded that the "surgery appears to have been otherwise uneventful. Intraoperative pressure recordings were consistent with a satisfactory repair. The pulmonary artery pressure was elevated but the left atrial pressure and central venous pressure were within expected range." (Exhibit 353, page 59) In their joint report, Cornel and Duncan noted that the patches appeared to be intact and appropriately placed. In his testimony, Dr. Walter Duncan said, "I think it was well done. This is a difficult repair, I think his patches were intact, his valves looked okay, his pressures were perfect." (Evidence, page 41,451)



Current Home - Table of Contents - Chapter 8 - The operation-November 1
Next Post-operative course
Previous Pre-operative status
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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