[HSF] CABG/Mitral Repair

[Tea Acuff]

She acts like MS. Is the LV small? Could she have any SAM also? Stop inocor and see the response? What you are doing is not working.
tea


----- Original Message ----
From: Edward Bender <ebender001 at charter.net>
To: OpenHeart-L <OpenHeart-L at hsforum.com>
Sent: Monday, March 12, 2007 9:27:56 PM
Subject: [HSF] CABG/Mitral Repair


Ten days ago a 52 year old obese diabetic female was admitted with  
unstable angina and class 3-4 heart failure.  She had cardiac cath  
showing a 25% EF, and tight LAD and Circ stenoses.  LV gram also  
showed severe MR.  No right heart cath was performed.  Echo showed  
severe MR with a dilated annulus and central regurg. There was no  
flail.  Her creatinine went from 1.6 to 3.6 in three days, then came  
back down to 1.3.  She had been in pulmonary edema, and this resolved  
with diuretics.  After waiting until her creatinine improved as  
above, this past Friday I did 2 vessel CABG and mitral annuloplasty  
with a 24 ETLogix ring and a couple of cleft closures.  No post-op MR  
on TEE.  In the OR her initial PA pressures were a little more than  
one-half systemic (systolic BP around 100).  After the operation her  
PA pressures were 30-15 with a systemic BP of 120/70.  Over the next  
24 hours, she whited out both lungs, her PA pressures have once again  
become high, she has required very high doses of pressors.  Any beta  
agonist drug causes horrific ventricular and supraventricular  
arrhythmias (even with ongoing cordarone and lidocaine).  I have her  
on inocor, vasopressin, and levophed.  A balloon pump was also  
placed.  Repeat echo shows LVEF about 40%, no MR, trace AI, and a  
dilated RV.  Her CVP is 20-25.  I dialed in Nitric oxide with some  
initial improvement in PA pressures, but not long-lasting.  Short of  
VAD therapy, anybody have any other tricks?

Ed Bender, MD
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------