[HSF] Apical saline insufflation

[Nasser F. Abou'Seada]

In case of open aortotomy, what sort / size of Foley's do you use ? Where do
you keep the balloon? beneathe the " annulus"? do you pull on it? .. if you
inflate it beneath the aortic "annulus" ... do you find that it affect the
AML ? .. do you think that "inflating" the LVOT might "push" the AML, in a
flaccid heart" affecting the credibility of the test in this very particular
situation ?

NFA


On 6/4/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> 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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC