[HSF] Inotropes, ventricular fibrillation and myocardial protection

Wed Aug 1 15:15:21 EDT 2007

Tomas,

  A fibrillating heart is a dying heart?  Is this an edict of some sort?  I've seen plenty of hearts that fibrillated during some part of their open heart operation only to have a completely, and I mean completely, normal EF on remote echo.  Speaking in absolutes serves no purpose.

Hal

-----Original Message-----
From: Salerno, Tomas <TSalerno at med.miami.edu>
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 1 Aug 2007 11:19 am
Subject: Re: [HSF] Inotropes, ventricular fibrillation and myocardial protection

A fibrillating heart is. "Dying" heart.
The brain does not have seizure during CPB; neither should the heart fibrillate.
Tomas

----- Original Message -----
rom: openheart-l-bounces at lists.hsforum.com <openheart-l-bounces at lists.hsforum.com>
o: OpenHeart-L at lists.hsforum.com <OpenHeart-L at lists.hsforum.com>
ent: Wed Aug 01 10:45:53 2007
ubject: Re: [HSF] Inotropes,ventricular fibrillation and myocardial    
rotection
Ani,
aving graduated from voodoo homemade cocktails to blood and its 
ariants, you would easily be able to see that the bad cardioplegia's 
id have a higher (more accurately uniform) incidence of fibrillation 
hich came down with better modifications of  cardioplegia's. That does 
ake us wary and anyway fibrillation is not something by any stretch 
ormal.Transient defibrillation may appear innocuous but then it has 
een shown that such hearts have indeed been improperly preserved (from 
orks of Buckberg and Kirklin).Remember that sometimes speed etc etc may 
ompensate but this may become an issue in  longer case.
rasanna
ni Anyanwu wrote:
 I still do not understand why we are alarmed about transient ventricular 
ibrillation on reperfusion and why using drugs to suppress it will have any 
mpact on outcome.

 Ani

> Date: Wed, 1 Aug 2007 11:51:47 +0530> From: prasannasimha at gmail.com> To: 
penHeart-L at lists.hsforum.com> Subject: Re: [HSF] Inotropes, ventricular 
ibrillation and myocardial protection> CC: > > I am not saying that the 
rocaine or lignocaine is still acting. What I> meant is that since the 
ibrillation is occurring with the hotshot delivery> with high local lignocaine 
hanging the drug class may be beneficial.> Prasanna> > On 8/1/07, Ben Bidstrup 
benjamin.bidstrup at bigpond.com> wrote:> >> > I beg respectfully to differ. The 
idocaine (a fast Na channel> > blocker) is all but gone after a short while in 
he cardioplegia> > scenario. Getting a suitable level back into the circulation 
nd thus> > the heart at release of the clamp is what is needed.> >> > Perhaps a 
andomised study is in the offing.> >> > http://circ.ahajournals.org/cgi/content/abstract/79/5/1106> 
> > This reference relates to defib energy levels but i think you will> > see 
here I am coming from.> >> > At James Cook, I was involved in the development 
f a non> > depolarising cardioplegia solution, which is slowly working its way> 
 up the development path. The main components are lidocaine and> > adenosine.> 
> >> >> >> > >Ben,> > >I use Amiadorone in the pump for all emazes (and postop) 
nd> > >Amiadorone in the pump for all aortic valves. Since the St Thomas> > 
Cardioplegia (which we mix in blood) already has procaine adding> > >Lignocaine 
ould be redundant.(Incidentally Amiadorone is very cheap> > >in India !!)> > 
Prasanna> > >Ben Bidstrup wrote:> > >>Why the amiodarone. Surely with some 
erfusion, the electrolyte> > >>imbalances within the myocardium would correct 
nd SR ensue. If> > >>anything use lidocaine. Less toxic and cheaper, not a 
egative> > >>inotrope. It is what Yacoub taught me many years ago, and I have> 
 >>used it to good effect (infrequently I might add).> > >>> > >>>Tohru,> > >>> 
 did an AVR on an 87 yo man as a 2nd case just a couple of> > >>>hours ago. 
gain, no LV vent, only a sump. While closing the> > >>>aortotomy, I began the> 
 >>>continuous warm retrograde blood. The heart began fibrillating> > >>>after 
 couple of> > >>>minutes. I gave amio and then cardioverted. The heart had a> > 
>>slow junctional> > >>>rhythm until the clamp was released. A sinus rhythm 
eveloped shortly> > >>>afterwards. He came off with no inotropes. It's much 
asier on> > >>>the heart and> > >>>your nerves to cardiovert a clamped, flaccid 
eart rather than> > >>>trying to do it> > >>>after the clamp has been 
eleased.> > >>> I look forward to your visit at the STS. As I said before, 
'll> > try to> > >>>have a couple of interesting cases for you and other 
nterested> > >>>members of HSF> > >>>to watch and criticize to your heart's 
ontent.> > >>>> > >>>Hal> > >>>> > >>>> > >>>> > >>>************************************** 
et a sneak peek of the> > >>>all-new AOL at> > >>>http://discover.aol.com/memed/aolcom30tour> 
 >>>_______________________________________________> > >>>OpenHeart-L mailing 
ist> > >>>> > >>>Send postings to:> > >>> OpenHeart-L at lists.hsforum.com> > >>>> 
 >>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > 
>>http://mmp.cjp.com/mailman/listinfo/openheart-l> > >>>> > >>>All messages 
ransmitted by the OpenHeart-L are subject to the policies> > and> > 
>>disclaimers posted at:> > >>>http://www.hsforum.com/listdisclaim> > 
>>-----------------------------------------> > >>> > >>> > >> > 
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nd I am> > not sure about the universe.> > Albert Einstein> >> > The greatest 
bstacle to discovery is not ignorance --- it is the> > illusion of knowledge.> 
 Daniel J Boorstin> >> > Ben Bidstrup FRACS FRCSEd FEBCTS> > Consultant 
ardiothoracic Surgeon> > _______________________________________________> > 
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