[HSF] aortic root replacement ,svere hyperbilirubinemia

[erdinç naseri]

Prasanna,
any other substance which will bind bilirubin.
> Date: Sat, 4 Aug 2007 19:59:44 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] aortic root replacement ,svere hyperbilirubinemia> CC: > > Erdinc, Keep the urine up with adequate hydration. Give Agar agar (China > grass) or any other bilirubin binding thing like Questran (We cannot > get that now) that you have that will help block bilirubin > re-absorption. How many units of blood did the patient actually receive. > Also run a Coombs test .> Prasanna> > erdinç naseri wrote:> > Dear members ,> > opinion requested regarding the following case:> > 70 y/o heavy smoker ( 80 years-pack)male with severe AR and root dilatation( annulus 5.7 ,valsalva 6.2,STJ 6.1,ascending aorta 5.6,EF good),Preop Spo2 92%,Htc 52%.No history of any defect of bilirubin metabolism. > > Aortic root replacement with cabrol modification( hand made valved conduit,carbomedics + vascutek),Xclamp 108 ,CPB 175,minimal dopamine on weaning,oozing which didn't decreased by fresh blood and FFP ( no platelets available),packed with sponges and taken to ICU.> > Hematuric urine which resolved in hours,no important drainage.Postop day 1 reopened and depacked .started bleeding from two deairing needle holes which resolved by hot sponge application.Reclosure and no bleeding untill evening . Evaluated for extubation and decided to give one unit of rbc and then extubate.(Htc 27 %, Spo2 90% on T tube).One unit given with no increase in Htc ,2.nd unit and then bilirubin stared rising to 7 same night 15 the next morning, 25 postop 2.nd day and 37 3.rd day.Creatinine up to 4 and then down to 2.8 today(direct bilirubin >60%,LDH 2000,AST 160,ALT 45,INR 1.57).Extubated and oriented but sleepy.Hemodynamics stable and in AF (NSR preop which converted toAF on postop 2.nd day)> > Bilirubin is going up. Comments> > erdinc> > _______________________________________________> > OpenHeart-L mailing list> >> > 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 transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > _______________________________________________> OpenHeart-L mailing list> > 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 transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------