[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

one leaflet was functioning easily "left hand side of the patient" ....
second one was stiff in the middle line vertically standing. "that to the
right hand side of the patient". ..... valve was inserted with leaflets
perpendicular to septum. no tissues intervening ... no nothing ..... valve
tested excellent when tried on insertion.

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Ben Bidstrup
> Sent: Tuesday, December 12, 2006 6:46 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: RE: [HSF] Valve Dysfunction - failure of Closure
> 
> What was the valve like when you opened the aorta?
> 
> >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
> >
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> 
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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