[HSF] [Fwd: Re: ccml Quiz for Christmas]

[claudia miranda]

Interesting case, Prasanna.
We usually think of a prominent X descent if the patient has cardiac
tamponade or constrictive pericarditis...but  an enlarged RV could produce
the same phenomenon, due to relative constriction by the pericardium. A
prominent X descent can also be a clue to regional tamponade causing RV
dysfunction.

Claudia


2006/12/29, Ani Anyanwu <anianyanwu at hotmail.com>:
>
> All?
> ----- Original Message -----
> From: Tea Acuff<mailto:tacuff at swbell.net>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> Sent: Friday, December 29, 2006 12:15 AM
> Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
>
>
> All ventricular dysfunction is worsened by the cross clamp. Hopefully one
> has otherwise improved its function and that it is only temporary.
> Tea
>
>
> ----- Original Message ----
> From: prasannasimha <prasannasimha at gmail.com<mailto:
> prasannasimha at gmail.com>>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> Sent: Thursday, December 28, 2006 9:49:31 AM
> Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
>
>
> Basically a case with severe TR and RV dysfunction worsened temporarily
> by CPB.
> Prasanna
>
> Tea Acuff wrote:
> > Etiology?
> > Tea
> >
> >
> > ----- Original Message ----
> > From: prasannasimha <prasannasimha at gmail.com<mailto:
> prasannasimha at gmail.com>>
> > To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> > Sent: Wednesday, December 27, 2006 9:38:35 AM
> > Subject: Re: [HSF] [Fwd: Re: ccml Quiz for Christmas]
> >
> >
> > No.
> > The curve was  showing a CVP trace with a prominent X descent suggestive
> > of either early tamponade or a dilated RV "restricted by the chest wall
> > / pericardium. There was simultaneous increased delta dip showing a
> > decrease in LV preload despite a CVP of 11 (volume loading was initially
> > tried) as the RV was not "sending" volume to the left side adequately.
> > Echo showed do diastolic collapse and RV dysfunction and was managed by
> > increasing support for the next 6 hours and was weaned off after the X
> > descent disappeared. Incidentally the chest tubes were removed as hey
> > were not draining and removal gave a little more "space " for the RV.
> > V. Aldrete, M.D. wrote:
> >
> >> Hi Prasanna,
> >>
> >> Did you have a drainage catether across the PA obstructing pulmonary
> >> flow?
> >>
> >> Victor
> >> On Dec 25, 2006, at 4:56 AM, prasannasimha wrote:
> >>
> >>
> >>> Part2 of the same quiz
> >>>
> >>>
> >>>
> >>> Same case next day morning. Stable and off inotropes prior to removal
> >>> of lines.
> >>> Prasanna
> >>>
> >>>
> >>>
> >>>
> >>> <quiz26answerfollowup.jpg>
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