[HSF] aortic root reimplantation and Rv dysfx

[Ani Anyanwu]

> a biomedicus or roller pump 2 - 3 liters per minute to help unload the RV> I have been surprised at how effective this can be.  > Ed Bender, MD
Ed when you say how effective this can be, are you saying you have salvaged patients in this manner or do you mean effective hemodynamically?
 
Thanks
 
Ani



> From: ebender001 at charter.net> Subject: Re: [HSF] aortic root reimplantation and Rv dysfx> Date: Tue, 4 Sep 2007 17:32:36 -0500> To: OpenHeart-L at lists.hsforum.com> CC: > > Leave the sternum open (usually you can close the skin over the open > wound). This alleviates mediastinal compression somewhat. In cases > of severe RV failure, obviously volume loading is required, but I > have squeaked by with a mechanical assist for 6 - 12 hours (I have > used the A-Med pump which Tea has blessed in the past or, in the > absence of that, use smal cannulae in the RA and PA, and flow with  > > > On Sep 4, 2007, at 11:11 AM, erdinç naseri wrote:> > >> > Would like to have the forum members opinion regarding the > > following case:> > 62 Y/O male with history of HT,CAD and COPD.( heavy smoker)> > CXR:Bilateral multiple bullae in the upper lobes,> > EKG:previous inferior MI and LVH.> > CAG:LAD90%,OM2 80%,RCA totaly occluded no ante or retrograde > > filling,no LV graphy> > TTE:AR 2-3 +,Aortic annulus 3.5 cm,Valsalva 4.3 cm,LVEDD 6.3 cm, > > Trival MR,TR 1 +,EF ( Simpson 's method) 25%,LV inferolateral akinesia> > Operation( hours ago): aortic and single stage venous > > cannulation,preparation of root during cooling showed dilataton of > > valsalva sinuses.Prox. RCA was at least 1.5 cm in diameter.on-pump > > beating heart LAD anastomosis while cooling. Trial of OM2 > > anastomosis lead to severe LV dilation .Anastomosis aborted and > > cross clamp with antegrade aortic root cardioplegia with periods of > > aortic root suction and LV compression. when the heart showed > > electromechanical arrest ante through LAD graft and retro through > > CS.Cooled to 24 degrees( operation room temp 28 ,air condition out > > of work!) and finished OM anastomosis and started giving > > cardioplegia through it .Exploration and arteriotomy of RCA > > showed a totally occluded vessel with very small (<1 mm ) > > PDA.Opened the aorta : oozing of desaturated blood from LC but nil > > from RC ostium.Aortic annular ,valsalva and STJ dilated but > > leaflets of good quality and coaptation.Decided to do root > > reimplantation .I was trying to be fast because of> > the inability to give cardioplegia to RV .Still further cooled to > > 24.Aortic root reimplantation and OM CABG in 121 minutes : gave > > hot shot and declamped .Heart started beating spontaneously at 28 > > degrees and after 10 minutes"of declamping.Continued with the > > proximals( LAD and Cabrol graft )to graft and OM to proximal > > arch).Everyting looked OK with Lv contracting good with no dilation > > ( no TEE available)Tried to wean and BP dropped with RV-RA > > dilation .CPB again and RCA endatrterectomy and by-pass to it with > > poor backflow distaly.30 more minutes on CPB and tried to wean but > > the same story.Changed the venous drainage to selective caval and > > did a warm beating tricuspid ring annuloplasty.Actually the > > leaflets were in good shape and coaptation before annuloplasty but > > I remebered Hal's advices regarding TR.CPB > 300 minutes and tried > > weaning with the following findings: LV small and contracting > > well,direct LA pressure 8 mmHg , RV stand still ,RA dilated;CVP 20 > > mmHg.Had started i> > notopics already ,increased the doses to suprapharmacologic > > levels ,put IABP ( it increased the MAP) and closed the > > sternum.ICU findings: MAP 65-70,ABG reasoable,good urination .> > My comment: İnappropriate RV preservation .Any additional measures > > could been taken ???> > erdinc> > _______________________________________________> > 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> > -----------------------------------------> > _______________________________________________> 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> -----------------------------------------
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