[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

Yes .... you are right ... it was so quick that it would have required a
rapid swift action ... often part of a protocol ... no time to think .... 
You were lucky to have had that happened on Table in OR .... we had it in
the middle of the night .... in ICU  .... 
wish I had your luck. 

NFA

> From: A
> It all seemed so quick I am sorry about that. Years ago there was a valve
> called "Duromedic" I had a similar incident with it but right on the table
> as we came off and started to close the valve became stuck in the open
> position back on the pump looked at the valve no reason for it to do that.
> Came off again the same scenario happened. I went back on the pump and put
a
> St. jude instead and the patient did fine. The same happened to my partner
> and we called the manufacturer eventually Duromedic was taken off the
market
> and that was one of the reasons. It is important to get in touch with the
> manufacturer and inform them. By the way what was the valve type? Thanks
 
> From: 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