[HSF] RV failure management strategies

[prasannasimha]

I used NO but ti was not very effective and switched to inhaled sodium 
nitroprusside.
Mechanical ventilation and blood gases have not been a problem. 
Coagulopathy was more due to severe TR with congestive hepatopathy.
She has stopped bleeding but hemodynamics are still dicey !!
RVAD is not an option in this patient for cost considerations and blood 
product availability though I would have preferred to at least use a 
Biomedicus pump support of the RV.
Prasanna
Alejandro Rey wrote:
> 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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