AW: [HSF] aortic root reimplantation and Rv dysfx

[Prasanna Simha]

Another thing is to use topical hypothermia (Remember that Dr Shumway 
used to use only hypothermia for his AVR series)`. It can be useful in 
such desperate circumstances and in such cases where we are unable to 
perfuse the right (for whatever reason) I try to give cold normokalemic 
blood continuously through the left ostium (with intermittent  K 
=Esmolol +Adenosine cardioplegia. This hopefully supplies the RCA 
territory via collaterals) and keeps teh myocardium cool. Along with 
this a cold mop over which a cold saline drip drips continuously can 
help.). Erdinc - this can be useful when the AC conks , the OT is warm 
and the headlight are hot !! A sump sucker placed in the pericardium can 
collect the excess water to an external suction.
As Hal metioned it may be important to get RV branches and conal 
branches. These can cause significant improvement in function.Sometimes 
there are multiple small ostial origins going to The RV and neglectingto 
include them in a button can cause significant RV dysfunction - it is 
better to take all of them together as one bigCVarrel patch and 
reimplant them onto the graft
Prasanna
Hgrmd at aol.com wrote:
> Erdinc,
>   I get the picture.  Tough case.  I've had the same problem  a couple of 
> times in patients with chronic occlusion of the RCA.  There's  really no good way 
> to reliably protect the right heart in those  circumstances.  I guess the 
> main protection is speed, and to graft any  branch to the RV that might be 
> graftable.
>  
> Hal
>
>
>
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