[HSF] 2 year old with severe AI and endocarditis

[rowlesjohn at aol.com]

Bill



Sounds like a very complicated case, and the cat may have been out of the bag before you arrived.



I am not a pediatric surgeon and I do not do the Ross operation, however, I wonder if there could have been a problem with the right coronary anastamosis and subsequent? RV ischemia.

Sounds like you did all that you could. I applaud your efforts and I am sorry for you and the family.

Sincerely,
John Rowles, MD


-----Original Message-----
From: ichfno at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Tue, 11 Dec 2007 6:15 am
Subject: [HSF] 2 year old with severe AI and endocarditis




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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