[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

I'd like to ask for the opinion of the forum members in a case of an adult
male patient, postoperative day 1, after AVR for rheumatic AVD, Mechanical
bileaflet prosthesis, simple procedure, totally stable, off ventilator,
speaking, to be transferred to HDU next morning. He was reported from CSICU
as being speechless for 2-3 seconds, during which his eyes were widely open,
gazing upwards, then returns back in 2-3 seconds totally normal. blood
pressure curve on monitor disappeared for a second. 
What is to be done ?? 

in a few minutes, before doing the ECHO, the attack was repeated twice in a
minute. 
?? reaction ??? 

in a few minutes the attack was repeated but never resolved back. Heart
beating, No clicking valve on auscultation, pressure curve up and down. 

Patient was re-intubated. CPR started, 
What is to be done then ?? 

Hanging of the valve leaflets with failure to close was suspected first
time. Echo -ready next room- was requested, yet second attack happened
before echo was done. 
Third time, the patient never came back, heart was beating vigorously, no BP
curve, no clicking of the valve. rapid intubation with CPR initiated, yet
never came back .... 
Faculty on call took the patient immediately to OR .... where the chest was
opened and patient was tried to be got on bypass ..... the aorta was so soft
to be cannulated ..... precious minutes were lost during trials of
cannulation. Pupils were dilated fixed already when aorta was cannulated at
last. Patient never made it back. 

Opinions about what should have been done ....?? ...... comments ???? 

NFA