[HSF] Apical saline insufflation

[prasannasimha]

Hal,
I make a small surface stab at the apex in an area free of fat , 
insinuate the tip of a thumb forceps to enter the ventricle and 
introduce a catheter and insufflate saline via the catheter till it 
ejects out of the aortic root vent which is kept open. This fills up 
the  ventricle with a pressure enough to come out of the aorta albeit in 
a flaccid state (which is its limiting feature). The only time I do not 
do this is when the apex is extremely fatty with no fat free zones (when 
I use the transmitral insufflation and curse myself or give cardioplegia 
and create AR by distorting the aortic root) or if there is an AVR being 
done when I full the LV via a Foley's the balloon of which is occluding 
the open aortic root
I do try to fill with saline and press the ventricle as you describe 
(What I meant by "fill and press" ) but find it is not as accurate - may 
be I am doing something wrong. It may hold but still does not fill up as 
well as the apical insufflation method. I usually use that only to check 
for how high the leaflets billow up to estimate the prolapsing segments.
Prasanna
hgrmd at aol.com wrote:
> 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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