[HSF] severe AS

[erdinç naseri]

Don,
I exactly do the same i.e insert the retro cannulae prior to the venous cannulae and guide it with my ringer inserted through the rA appendage.
erdinc> From: donross at bigpond.com> Subject: Re: [HSF] severe AS> Date: Wed, 22 Aug 2007 07:12:33 +1000> To: OpenHeart-L at lists.hsforum.com> CC: > > Ah, the getting of wisdom.> Nice save, erdinc. You are to be congratulated for not accepting poor > protection as the cause of the problem.> I had a similar case in my formative years. The diagnosis was made > because the LV remained cool after release of the clamp.> BTW to guarantee placement of retrograde cannula place it before the > venous cannula, then you can put a finger into the RA through the > venous line purse-string. There is usually a membrane blocking the CS > ostium which is easily ruptured and then the cannula can be guided > with your finger.> Don> On 22/08/2007, at 1:12 AM, 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> -----------------------------------------