[HSF] aortic root reimplantation and Rv dysfx

Edward Bender ebender001 at charter.net
Tue Sep 4 20:20:28 EDT 2007 

Both. And by both, I mean I have had two cases where I have used the  
right sided pump, both improved dramatically however one died  
remotely from the acute insult of prior co-morbid conditions.

Ed Bender, MD


On Sep 4, 2007, at 6:35 PM, Ani Anyanwu wrote:

>> 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 +,Aort
>  ic 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 annu
>  loplasty 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> >  
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