[HSF] PA versus LV Vent

[Nasser F. Abou'Seada]

That is typical of a lecture synopsis style Prasanna. Wikipedia ?

NFA

On 5/7/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> Persistent fibrillation can be due to subendocardial Ischemia and gets
> relieved by either venting appropriately and defibrillating, dropping
> flows and defibrillating or cross clamping venting and defibrillating or
> using a retrograde and warm retrograde perfusion with aortic venting and
> getting the heart to beat before the X clamp is removed. (The last seems
> always to be the best). If nothing works secondary cardioplegia needs to
> be administered.
> Prasanna
>
> Edward Bender wrote:
> > When I use a vent (rarely), I usually put it in the main PA.  I also
> > try not to place the vent deeply into the left PA below the level of
> > the LV.  I avoid that because, I think that, if the seal around the PA
> > vent entry site is not too tight, one can entrain air into the central
> > circulation, making de-airing an issue.  I don't think you can
> > adequately decompress more than mild AI in a non-beating heart via the
> > PA, but, on the other hand, if you have more AI than that you should
> > be fixing it.  I have never heard the argument stated below, and have
> > never heard of "vent-induced" lung injury.  I have had an apical vent
> > blow out requiring an ICU sternal re-explorarion.  I have also had a
> > LA vent go out the side of the LV, requiring a couple of stitches.  I
> > have also had a PA vent blow out resulting in the death of a patient
> > with severe pulmonary hypertension following a  redo mitral
> > replacement.  This was the only time I did not use pledgets for my
> > vent pursestring.  Since then I always use pericardial or vein
> > pledgets on the pulmonary artery.  The situation that I am most likely
> > to require a vent is an on pump cabg requiring multiple defibrillation
> > attempts with tenuous blood supply.  In that case, I hook up all my
> > grafts to a multiperfusion device, stick a pericardial sump into the
> > PA, and then defibrillate.  It seems to work every time.
> >
> > Ed Bender, MD
> >
> >
> > On May 7, 2007, at 3:18 PM, hgrmd at aol.com wrote:
> >
> >> Dear Members,
> >>   One of the senior members of my group and I were discussing the
> >> merits of using a PA vent versus an LA vent when encountering LV
> >> distension just after releasing the clamp.  Typically, it is due to
> >> mild or moderate AI.  Personally, I prefer using the main PA as the
> >> vent site.  It's quick and easy, and I've always found that it
> >> decompressed the LV nicely.  In contrast, my friend says that it's
> >> better to use an LV vent so as to avoid pulling all of that blood
> >> through the capillary beds and risking acute pulmonary injury.  I've
> >> never read that, and it sounds like theoretical crap to me.  What do
> >> you think?
> >> Hal
> >>
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC