[HSF] Image of the week Bronchial compression

[Tea Acuff]

It depends how much better can the patient get and how quickly the patient needs surgery.

Can you describe your LA plication in more detail? Did you ligate the LAA?

tea


----- Original Message ----
From: Prasanna Simha <prasannasimha at gmail.com>
To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>; ccm <ccm-l at ccm-l.org>
Sent: Tuesday, October 30, 2007 11:44:59 AM
Subject: [HSF] Image of the week Bronchial compression

12 year old boy 19 Kgs (Expected 36 Kgs) with h/o severe MR repeated 
respiratory tract infections and cardiac failure. Developed in house 
severe RTI on admission which was treated.  Note the severe left 
bronchial compression and displacement -compression of right lung by the 
left atrium.
Patient underwent a Kay annuloplasty (sized to 24 Hegar - expected size 
for BSA) for TR, a mitral valve repair with a 32 Indigenous Goretex 
steel ring (patient had A123 and P12 prolapse) requiring combined 
chordoplasty of all anterior chordae and the prolapsing P1/2 junction 
was managed by imbrication of the prolapsed area . Annular remodeling 
was done with the 32 Ring. The transapical saline insufflation  showed 
good mitral competence which was confirmed by post CPB epicardial 
echocardiography
The bronchial compression was relieved by atrial plication of the dome 
and inter pulmonary vein area and excising a strip of the atriotomy 
during closure. Child had preop and immediate post op poor gases which 
was managed by serial open lung maneuvers and PEEP . The child's 
oxygenation improved and was extubated after 6  hours after surgery and 
has maintained good gas exchange and was shifted to the ward next day.
How early do the members feel that they can one go in to do a case on 
CPB safely after a bout of pneumonia ?
Prasanna



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