[HSF] PA versus LV Vent

[erdinç naseri]

Ani,
you can also use trans septal apprach through the RA if only the RA is exposed and the heart fibrillates with LV distention.Hold  a no.11 balde together with the usual LA vent ( blade 5mm lower than the vent ),stab the RA free wall and insert into theRA and then trans septaly ( again stab ) LA.
erdinc> From: anianyanwu at hotmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] PA versus LV Vent> Date: Mon, 7 May 2007 22:44:28 -0400> CC: > > Michael> > I am curious to know why you say PA venting is not something you are going to be doing anytime. > > PA venting should be in the armamentarium of every cardiac surgeon. In my limited experience I, like you, have never routinely vented the PA and have also not worked for a mentor who did. However I have used it on occasion. There are specific situations where PA venting is the most expeditious and preferable way to decompress the heart, such as a heart distending after clamp is released with no other vent in place, when you crash back on bypass with a boggy distended heart, where suture lines, adhesions from prior surgery or other surgical factors prevent quick access to your preferred venting site. I would also not write off the LV apical vent either. There are also situations where this route may be ideal for decompressing the heart; it is certainly the most effective. > > All venting routes, PV, PA, LV and even RV transeptal (particularly useful to decompress the fibrillating heart in AI redo before heart is dissected) should be within the armamentarium of all surgeons and while we all have our preferences we should be well versed with all approaches. Certainly you (and I) are too young to write off any approach.> > Ani> ----- Original Message ----- > From: Michael Firstenberg<mailto:msfirst at gmail.com> > To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> > Sent: Monday, May 07, 2007 5:17 PM> Subject: Re: [HSF] PA versus LV Vent> > > Now, I may just be a simple young surgeon, but if the LV is getting> distended from AI how is venting the PA going to help? (suck the blood> back??). Am I missing something? I have seen 1 PA vent as a Fellow (and I> was on the thoracic service at the time walking thru the ICU, POD #2) - and> let me just say, not something that I am going to be doing anytime> soon.......> > > -michael> > > On 5/7/07, Igor Rudez <rudi at kbd.hr<mailto:rudi at kbd.hr>> wrote:> >> > Since we started using PA vent more than a decade ago, we have never had> > disasters as uncontrollable LV bleeding, and, believe me, I have seen a> > couple of patients end up dead because of LV vent complications!> > Regarding pulmonary injury, never read about that either, but on the other> > hand, I'm just a simple surgeon!> > ;-)> >> > Igor> >> > -----Original Message-----> > From: openheart-l-bounces at lists.hsforum.com<mailto:openheart-l-bounces at lists.hsforum.com>> > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of hgrmd at aol.com<mailto:hgrmd at aol.com>> > Sent: Monday, May 07, 2007 10:18 PM> > To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>> > Subject: [HSF] PA versus LV Vent> >> >> > 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> > ________________________________________________________________________> > AOL now offers free email to everyone. Find out more about what's free> > from> > AOL at AOL.com. _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l<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<http://www.hsforum.com/listdisclaim>> > -----------------------------------------> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l<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<http://www.hsforum.com/listdisclaim>> > -----------------------------------------> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l<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<http://www.hsforum.com/listdisclaim>> -----------------------------------------> _______________________________________________> 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> -----------------------------------------