[HSF] RV failure management strategies

[Ani Anyanwu]

mmm...and the morale of the story????
  ----- Original Message ----- 
  From: Edward Bender<mailto:ebender001 at charter.net> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Thursday, November 30, 2006 11:11 PM
  Subject: Re: [HSF] RV failure management strategies


  I used the Amed pump for RV failure in a similar situation.  After 8  
  hours of RV support, everything improved, the pump was explanted, the  
  patient was transferred out of the ICU the next day and subsequently  
  went into V-fib and died.

  Ed Bender, MD


  On Nov 30, 2006, at 9:24 PM, Tea Acuff wrote:

  > It seems to me that proper treatment of RV failure likely depends  
  > on its etiology and is largely unrelated to RV effects itself. I am  
  > of the belief that acute ischemic RV failure is a contradiction for  
  > almost any indication of LV revascularization. The treatment is  
  > volume to the LV which is in turn deadly to the ischemic LV. I used  
  > the Amed device, which unfortunately got pushed into the Embolex  
  > venture for economic and ultimately fatal device reasons, for about  
  > 50 OPCABs and was impressed in its small size and 50-60cc internal  
  > volume in supporting CO in the contorted RV even when the LV was  
  > not working. RVs unlike LVs do seem to have the capacity to recover  
  > if LV filling can be maintained in the ischemic/ failing R  
  > ventricle. Fontan physiology seems to suggest the same argument. I  
  > don't know if models of primary RV failure exist as isolated RV and  
  > even RV valvular problems are rare. Almost all surgical treatments  
  > of the LV temporarily worsen the resistance to flow faced by
  >  the RV except if the LV can be markedly improved. In other words I  
  > think the question itself is largely misstated. Kind of like asking  
  > how can one get better pacing when the patients is in  
  > electromechanical dissociation (to use old descriptives.)
  > This kind of BS reasoning is one looking for counter arguments (and  
  > better understanding).
  > Tea
  >
  >
  > ----- Original Message ----
  > From: prasannasimha <prasannasimha at gmail.com<mailto:prasannasimha at gmail.com>>
  > To: "OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>" <OpenHeart- 
  > L at lists.hsforum.com<mailto:L at lists.hsforum.com>>; ccm <ccm-l at ccm-l.org<mailto:ccm-l at ccm-l.org>>
  > Sent: Thursday, November 30, 2006 8:40:26 PM
  > Subject: [HSF] RV failure management strategies
  >
  >
  > 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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