[HSF] 2 year old with severe AI and endocarditis

[ichfno at aol.com]

We arrived at one of our sites to find a 2 year old just admitted to the ICU, intubated, on 10 of dopamine, lasix infusion, and 0.75 of milirinone. He had been treated for bacterial endocarditis for 1 month and over the last week had developed increasing heart failure and respiratory distress. On the day of our arrival he essentially gave up, respiratory arrest on the floor, severe bradycardia and was rushed to the unit, intubated and placed on above meds. Six weeks prior to arrival had an embolic ischemic CVA, R hemisphere, minimal residual, but following respiratory arrest was not arousable, when we arrived, 3 hours after intubation. 

Chest xray, massive LV, pulmonary edema, creatinine 2.2 (in a 2 year old), oliguria ( less than 0.5 cc/kg/hr on 1 mg/kg/hr lasix infusion) LFTS all off the wall, with a diastolic bp of 22 and echo with free AI and vegetations. 

What to do, we did emergency Ross the next day. Came off on 0.75 milrinone, epi 0.1 and dopa 5. Dried up nicely, however over the ensuing 2 hours developed progressive hypotension, rising CVP and required increasing support. Back on bypass after 2 hours, eventually died despite 6 additional hours of bypass support, no ECMO available.

Thoughts?

WNovick


-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Tue, 11 Dec 2007 5:22 pm
Subject: Re: [HSF] Restrictions after aortic surgery



Mitch,
  Nice job.  BTW, mannequins aren't designed for post LV  aneurysms.  
However, I've found them quite helpful in determining the  optimal size with the 
more 
common anteroapical aneurysm.  I'm glad your MVR  worked well from the 
ventricular side.  However, I would have probably done  it via a standard 
atriotomy. 
 The time necessary to open and close a left  atrium is generally 
inconsequential.  Why did you not repair, rather  replace the valve?  Was the 
posterior 
papillary muscle attenuated?
 
Hal



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