[HSF] Embol-X

[hgrmd at aol.com]

Erdinc,
  Sounds like a good protocol, but TEE guidance is best.
Hal 
 
-----Original Message-----
From: enaseri at hotmail.com.tr
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 2 Mar 2007 8:09 AM
Subject: Re: [HSF] Embol-X


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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