[HSF] Embol-X

[erdinç naseri]

We have noticed that sometimes after the intracardiac operations( 
valve,congenital,...) even after 30 minutes of aortic root venting there are 
air bubles coming out of the LV.Here is our weaning and decanulation 
protocol.
1.Ventilating the lungs in increasing increments while warming.
2.gentle manual massage and lifting of the heart from pericardial sac.
3.Termination of CPB
4.Taking out venous canulae and continue venting from aortic needle.(return 
the vented blood through aortic canulae)
5.Remove vent needle.
6.Give protamine.
7.carefully inspect aortic cannulae for several minutes.( small bubles 
always  come to the canulae)
8.If large amount of air is present deair thruogh luer lock of the cannulae 
and inspect for several more minutes)
9.Aortic decanulation
Erdinc


>From: Hgrmd at aol.com
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] Embol-X
>Date: Fri, 2 Mar 2007 07:05:12 EST
>
>Dear Dr. Bachet,
>   Like you, I've been concerned about the air balls seen on TEE during  
>live
>surgery.  I've sometimes been off CPB 15-20 minutes before I remove  the
>needle vent in the root.  If you are worried about tying a pressurized  
>aorta,
>simply transiently drain blood from the venous line until the pressure is  
>at a
>level you can comfortably tie.
>   Interestingly, I've found that air balls are essentially  eliminated in 
>the
>minithoracotomy cases where CO2 is continuously infused  into the closed
>chest.  When I visited Fred Mohr's program a couple of  years ago, I 
>noticed that
>he doesn't even vent the root in his MIC  mitrals.  Any potential air is
>removed by the LV vent.  The only  potential source of nitrogen in such 
>cases is
>careless introduction of air  bubbles when doing the saline test of the 
>repair.
>My experience has been  similar to his.  This eliminates the stress of 
>tying
>the aortic root vent  stitch through a tiny incision.
>Hal
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