[HSF] RV failure management strategies

[Goldman, Scott]

Try Natracor, Flolan, iNO and/or Viagra 


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com on behalf of prasannasimha
Sent: Thu 11/30/2006 9:40 PM
To: OpenHeart-L at lists.hsforum.com; ccm
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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