[HSF] Apical saline insufflation

[hgrmd at aol.com]

Prasanna,

  Tell me again exactly what you do when you do apical insufflation.  One way I make the saline test even more predictive of the post-CPB TEE is to fill the ventricle with saline and then press firmly across the anterior RV and LV.  This pressurizes the LV even more.  I've found that it will reveal occult leaks better than just passively filling the LV with a bulb syringe.

Hal


-----Original Message-----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com <OpenHeart-L at lists.hsforum.com>
Sent: Mon, 4 Jun 2007 1:10 pm
Subject: [HSF] Apical saline insufflation



This is an old picture of a repair done with a pericardial band. You can see the excellent coaptation while the ventricle is insufflated apically with the fluid egressing from the aortic root vent demonstrating full filling and distention of the ventricle. Such a result correlates very well with periop and postop TEE. Striving for that makes decision making simple. 
Somehow for me the transmitral insufflation seems to be faulty at times as usually a "lip" can "unfurl" demonstrating a leak under pressure and appears competent with plain transmitral insufflation.Lots of people use it successfully but it is not a good method in my hand. (Despite trying to use the parrallel line of coaptationa and fill and press rules etc etc. Could people educate me on this further. I obviously am doing something wrong with that method though I seem to have no problems with the apical saline insufflation method. My colleague has become so convinced with apical saline insufflation that he always asks me to do it in addition (It is my habit to call some one else and always demonstrate it to them also - sort of an internal quality control) 
Prasanna 


 


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