AW: [HSF] aortic root reimplantation and Rv dysfx

[Hgrmd at aol.com]

Erdinc,
  Thinking further about your unfortunate patient, one thing you might  have 
considered trying was to bypass any acute marginal or RV branches to see if  
that would improve RV function.  About 3 weeks ago, I had a 62 yo diabetic  
woman with severe 3VD, and a left atrial myxoma.  The RCA was diffusely  diseased 
with an ungraftable PDA and a small posterolateral RCA.  I did a  LIMA to the 
LAD, and vein grafts to the diagonal and OM2 as well as excision of  the LA 
myxoma.  When we came off pump, TEE now showed 3+ MR with a large  central jet 
and no prolapse.  I figured it was ischemic MR.  I went  back on, clamp, and 
did an ETlogix ring.  We came off again, no MR, and the  EF looked to be about 
35%.  I gave protamine and removed the venous  cannulas.  Suddenly, I saw the 
pressure was in the 30's, and the RV was  dead.  I gave heparin and massaged 
the heart until I figured the blood was  thin.  Fortunately, the aortic cannula 
was still in.  I stabbed the RA  and jammed in bicaval cannulas.  Now what?  
I found the crappy little  posterolateral branch as well as an acute marginal, 
and sequenced a vein graft  to both.  Guess what?  The patient flew off pump. 
 The RV looked  fine, and she had an uneventful recovery.  Obviously, if I 
hadn't done the  graft to the right system, the patient would have died.
 
Hal



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