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After many hours

She has got a hole in her heart.

She needs a bypass to fix it, and she needs it now.

The bypass would mean a lot of heparin.

It is a setup for a re-bleed.

The hypothermia would kill her.

Traumatic V. S. D. S can close on their own.

This is why we should wait to repair the heart.

She's not stable enough to wait.

Her pressure's bottoming out.

Belly's tight as a drum.

Flash pulmonary edema.

Her lungs are full of fluid.

Abdominal compartment syndrome.

She's bleeding out. Alert an O.R. that we're on our way down.

Got some new bleeding.

Remove the abdominal packs carefully.

They may be stuck.

Irrigation.

I'm starting to cannulate.

Slowly push the heparin.

We've got blood!

Damn it.

We gotta go back in.

It's the heparin.

We need to reverse the heparin and try the percutaneous repair.

Get me a percutaneous catheter kit.

Flip on the echo. I am going up through the groin.

Removing the needle over the guidewire.

Catheter.

Forceps.

Suction Dr. Koo.

It's going in easy. Get the T. E. E. ready.

Still got some active bleeding coming from somewhere.

Well, then let's recheck the retroperitoneum.

I've got access.

Forceps. Give me some suction.

Clamp and give me a tie, please.

The brain is decompressing. The balloon is advanced.

Extra-stiff guidewire, please.

Brain bleed has been controlled.

Okay, the occluder's in. Turn on the doppler.

Minimal residual V. S. D. flow. Good.

Then we're done here.

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