[HSF] Apical saline insufflation

[prasannasimha]

A very valid question and can make a mess  with a neophytes 
attempts.(Been there and done that and learnt the hard way !!). It is 
important to keep the balloon in the root above the annulus  and it 
helps to snip of the tip of the Foley's so that just the tip is in the 
ventricle and then the balloon just inflates and occludes the open aorta 
. Insufflation now fills the LV.
Prasanna

Nasser F. Abou'Seada wrote:
> 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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