Occluded circulation

doi:10.1136/bmj.a992

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Jules Dussek, retired cardiothoracic surgeon, Sevenoaks

jules.vanessa.dussek{at}btinternet.com

Thirty years ago my boss had told me of an aortic valve replacement he had performed. The heart came off bypass well with a good output, but later it was apparent that, although the patient’s legs were warm to the touch, there was no pulsatile flow. “It was as if,” he said, “there was a sponge in the aorta.” And then the penny dropped. During the operation, it was customary to put a sponge in the left ventricular cavity …