[HSF] RV failure management strategies

[prasannasimha]

Flolan  = prostacyclin ?
Prasanna

Goldman, Scott wrote:
> 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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