[HSF] Apical saline insufflation

Tue Jun 5 14:37:52 EDT 2007

Keeping the balloon above the annulus, with full aortotomy?

NFA

On 6/5/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> 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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC