[HSF] CABG/Mitral Repair

[erdinç naseri]

Dear Dr .Bender,
what is your explanation for the pathophysiology of this case?
erdinc


>From: Edward Bender <ebender001 at charter.net>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] CABG/Mitral Repair
>Date: Tue, 13 Mar 2007 02:07:44 -0500
>
>she's on amrinone - same class of drug.  I just did TEE and she has  no MR, 
>no MS, very dilated RV and decent LV function.  Anuric and  hypoxic.  I 
>think she is lost. Thanks for all of your responses.
>
>Ed Bender, MD
>
>
>On Mar 13, 2007, at 12:18 AM, Donald Ross wrote:
>
>>Do you have Milrinone?
>>It is an inotrope ( phosphodiaesterrase inhibitor ) and also a  peripheral 
>>dilator.
>>Don
>>On 13/03/2007, at 1:27 PM, Edward Bender wrote:
>>
>>>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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