[HSF] severe AS

[erdinç naseri]

Prassana,
Although I decalcified the root very intensely and 24 sizer was very freely  moving inside it ostial compression was my first bet but again there was free efflux of the cardioplegia from LCS when given from RCS.The order of knotting in AVR is as follows:LCC,RCC,NCC in my practice.We don't have vacuum assisted venous drainage and would appreciate to give more information on Fabiani tech.
erdinc> Date: Tue, 21 Aug 2007 21:48:31 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] severe AS> CC: > > Ostial compression has been described when an oversized prosthesis has > been used. This can be avoided (first by avoiding an overtly large > prosthesis) by augmentation of the aortic incision to allow some > ballooning (which you did) and seating the prosthesis first in the left > coronary sinus.I usually always note if the retroplegia effluxes out the > left ostium as a rule after implantation of a valve.One way to give > cardioplegia when the CS is noncannulatable is using Fabiani's technique > for which you need to swtich to a two stage cannula. This should not be > a problem if you have vacuum assist.> > Prasanna> erdinç naseri wrote:> > Dear members,> > opinion is requested regarding the following case:> > 73 Y/O male with chest pain.> > CAG:RCA 40% stenotic ,otherwise normal> > TTE:severe AS( 0.7 cmm2,Max gradient 108,LVPWd 20mm),MR mild,PAP 40 > > Taken to the operation yesterday .Cannulated by a junior colleague of mine but couldn't put retrograde cardio cannulae. When I attended he was 30 degrees and in VF.Defibrilation attempted several times but useless.Immediate cross clamping and aortotomy with antegrade tepid blood cardioplegia arrest.Arrested immediately and continued to 28 degrees.Tried to put retro transatrialy but unsuccessful . attempted external application of retrograde to coronary sinus but no way.Aortic valve rocky hard .It took 20 minutes for complete excision and decalcification. (Ventriculoaortic continuity geopardized around all commisures).24 mm annular diameter by sizer.Direct cannulation of the coronary ostia and antegrade continous hyperkalemic cold blood.LMCA was around 3 mm in diameter.İmplanted a Sorin Soprano( supra annular) 22 mm with pledgeted sutures( on the ventricular side) in anatomic position( horns in the commissures).Aortotomy closed by interposition of 2 cm wide graft in betwe> > en to reduce the tension on suture line.X clamp 61 minutes. Declamp but no effective cardiac activity for 15 minutes.LV distended and VT unresponsive to defibrilation. Started to sump the LA ( usually don't do it while declamped)..Lv distention continued .ASked for TEE ( done by cardiologists) but a technical problem happended in the probe .Reclamped and gave one dose of hot shot.Declamped with cardiac silence for 5 minutes" a nd then the story began again.Reclamped and cooled to 26 degrees and opened aortotomy.Coronary ostia open but LMC ostium just behind the sewing ring.Explanted the valve and put 19 mm Carbomedics with the same suture technic.Closure of aortotomy with patch.Hot shot and declamped. Cardiac activity returned in 30 minutes and weaned from CPB with minimal inotrope.> > 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> -----------------------------------------