[HSF] CABG/Mitral Repair

[Tea Acuff]

TRALI?
tea


----- Original Message ----
From: "jbflegejr at aol.com" <jbflegejr at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, March 13, 2007 7:06:05 AM
Subject: Re: [HSF] CABG/Mitral Repair


Could this be TRALI? John Flege

-----Original Message-----
From: ebender001 at charter.net
To: OpenHeart-L at hsforum.com
Sent: Mon, 12 Mar 2007 10:27 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 
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