[HSF] acute aortic insuffiency dure to BE

[erdinç naseri]

Dear Dr.s Harris and prassana,
while doing closed chest massage we could not maintain  a reasonable blood 
pressure for several minutes and this may lead to a wide spectrım of 
neurologic dysfunction  in a  60 odds y/0 lady on HD for the past several 
years.Cooling the brain would not revert  neuronal damage. I preffered to do 
nothing and wait due to our past experience in several occasions like this 
where we put all our and our team's effort to do an excellent operation but 
the patient never wakes up and CT shows huge multiple brain infarcts.
If this was  a young patient with  without any other organ malfunction I 
would definitely proceed as your recommendations.
erdinc


>From: David Harris <drdharris at yahoo.co.uk>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] acute aortic insuffiency dure to BE
>Date: Wed, 21 Feb 2007 21:52:50 +0000 (GMT)
>
>For THIS case I would have had the pump primed and
>ready, and would have gone on pump immediately, with
>cooling, to protect brain. Would have considered
>femoral bypass whilst colleague continues to massage
>chest.
>
>--- erdinç naseri <enaseri at hotmail.com.tr> wrote:
>
> > Dear forum members,
> > On monday morning we took the patient with Acute AI
> > and bacterail
> > endocarditis to operation.( blood culture showed
> > enterococci sensitive to
> > VM).Induction of anasthesia lead to deep hypotension
> > and bradycardia
> > followed by cardiac arrest.10 minutes of external
> > chest massage and
> > adrenaline and dopamine ,cardiac activity
> > returns.was not sure about the
> > neurologic condition so didn't proceed with
> > operation and took the patient
> > back to the ICU.Informed the family about the
> > possibility of neurologic
> > damage.She woke after 10 hrs and now is without
> > deficit.Family refused
> > operation for 3 days but today they accepted the
> > operation again. BTW
> > anesthesia inadvertently put a catheter in her left
> > subclavian artery(blood
> > running up to the fluid bottle) and I am planning to
> > take it out in the
> > operation room.We used CVVHDF in these 3 days. very
> > effective lowering of
> > blood creatinin and K levels.(we don't have any
> > nephrologist so we manage
> > the CRRT).Control Echo :mobile mass originating from
> > NCC 5
> > mm,AI+++,MI++,TI++.Will try once again.
> > ERdinc
> >
> >
> > >From: Hgrmd at aol.com
> > >Reply-To: OpenHeart-L at lists.hsforum.com
> > >To: OpenHeart-L at lists.hsforum.com
> > >Subject: Re: [HSF] acute aortic insuffiency dure to
> > BE
> > >Date: Mon, 19 Feb 2007 07:21:27 EST
> > >
> > >Bob,
> > >   Actually, it's my case, and I'm leaving in a few
> > minutes to take  care
> > >of
> > >it.  In my opinion, this pt's AI if chronic.  I
> > noticed in his  chart that
> > >he
> > >had been treated by a rheumatologist for
> > "rheumatica myalgia"  since last
> > >September.  SBE was probably the culprit.  If you
> > look at  the patient, he
> > >seems
> > >fine.  In fact, he's roaming the halls with wide
> > open  AI, mod MR, and
> > >mod-severe TR.  I'll let HSF know what I find
> > >Hal
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>
>Dr. David G. Harris, FCS, MMED,
>Cardiothoracic Surgeon
>Suite A2
>Tygerberg Hospital, 7505
>Cape Town, South Africa.
>Tel +27-21-9762347
>Fax +27-21-9761157      Mobile +27-83-3309587
>_______________________________________________
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