[HSF] RV failure management strategies

[Alejandro Rey]

Sir,

One of the most important things in this patient is his age as 
well as renal function. And do you have prostaglandin or 
nitrous oxide to low his high (?) pulmonary artery pressure 
and how is mechanical ventilation, FiO2, Peep, and blood 
gases. Coagulopathy is because long aortic cross clamp time 
or long cardiopulmonary bypass or hepathic dysfunction 
secundary to RV failure.

If your patient is not very old and has good renal function 
could have long ICU stay but good recovery, specially if you 
support him with RVAD but cost is really high. Could you tell 
us more about him. Good luck, you will need it.

Alejandro Rey
University of Mexico








> ----- Original Message -----
> From: prasannasimha <prasannasimha at gmail.com>
> To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-
L at lists.hsforum.com>, ccm <ccm-l at ccm-l.org>
> Subject: [HSF] RV failure management strategies
> Date: Fri, 01 Dec 2006 08:10:26 +0530
> 
> 
> Can the list members enumerate their management 
strategies for RV failure.
> This is for two reasons. _ one for th3e Wiki and presently
> I have  a patient who was in low output  and taken for a 
semi 
> emergency MVR with maze with TV plasty. Patient had RV 
dysfunction 
> and congestive hepatopathy. Had a difficult wean - LV 
good but RV 
> function was pretty poor. Patient is in coagulopathy which 
seems to 
> have decreased .No mechanical problem on epicardial 
echo.
> Patient has an open chest and has adequate CI (PA cath 
with CCO) 
> has a high PVR and low SVR and is requiring multiple 
inotropes 
> (Dopa = Dobut +Adrenaline + Norad +Milrinone and 
Vasopressin on one 
> hand and multiple vasodilators on the other (getting 
constrictors 
> via the central lumen of the IABP and dilators via the PA 
catheter) 
> . I put the IABP as the patient has OK CI but low pressures 
due to 
> a vasoplegic state and was worried that the coronary flow 
may not 
> be adequate creating a vicious spiral 9and is helping in 
> maintaining pressures).
> Funny thing is patient has bilateral dilated and fixed 
pupils but 
> has actually woken up once !! (On an infusion of morphine 
+ 
> Ketamine)
> Prasanna
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