AW: [HSF] aortic root reimplantation and Rv dysfx

[erdinç naseri]

Hal,
I also considered by-passing whatever I find in the RV territory .This was the reason for enartetrctomy and by-pass to RCA after 1.st weaning trial. there were no suitable acute marginal branches. Beside the problem was inadequate myocardial protection and the RV was already injured .
erdinc
> From: Hgrmd at aol.com> Date: Wed, 5 Sep 2007 21:10:26 -0400> Subject: Re: AW: [HSF] aortic root reimplantation and Rv dysfx> To: OpenHeart-L at lists.hsforum.com> CC: > > 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> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> 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> -----------------------------------------