AW: AW: [HSF] aortic root reimplantation and Rv dysfx

[Dr. Roberto Battellini]

Erdinc,

as an old surgeon, I remember the old times ort he "ice era", we covered the
heart with ice and the protection of the right heart was excellent. Also I
remember being 10 days at Stanford in 1982: Dr Shumway did not perform
cardioplegia, but made a bath of very cold saline the whole time, in the
pericardial sac, with excellent clinical results. I saw him personally.Add
this to your armamentarium for those cases.
Considering retrograde cardioplegia, if you have a two stage cannula you are
not 100% sure that the cannula is just exactly at the coronary sinus ostium,
but if you use double cannulation, then yes. Did you begin with double stage
and changed?
And for Tric insuf only grade one I would not have considered it the cause
of the problem.
Was the core of the endarterectomy complete? Was the distal anastomosis on
the descending posterior?
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von erdinç naseri
Gesendet: Mittwoch, 5. September 2007 19:12
An: openheart-l at lists.hsforum.com
Betreff: RE: AW: [HSF] aortic root reimplantation and Rv dysfx


Dear Robertto,
 
> It seems a little confuse and complicate OP.> If you have 3 vessel disease
with impossibility of revascularization of the> RCA, you must do LIMA-LAD
and radial to OM in a 62 years old patient.
1.I didn't use Lima because:he was pysiologicaly much older then his real
age,his lungs were very close to end -stage lung disease and hyperinflated
and I thought that lima's length won't be sufficient.
> Retrograde cardioplegia, with the balloon in the ostium of the CS plus>
ostial cardioplegia are excellent protection. 
2.THis is exactly what I did.
A very little RCA doesn't need> to be revascularized but the RV needs to be
protected.
3.Rca stump was huge but there was"total occlusion.
 
> Was the aortic valve insufficient? 
4.++ AR
Then the best protection is to begin with> retrograde and when you have
given 1000 ml of blood cardioplegia, add 500 ml> through the RCA ostium. 
5.I gave continous Cs and graft cardioplegia througout the case.
 
> Why did you cooled so much? It was not a circulatory arrest??
6.No effective cardioplegia to RCA domain  (thus  part of septum and whole
Rv ) so I tried to use hypothermia as the method of myocardial protection
for those segments.No TCA.> > I would have not done the endarterectomy if
the artery was a little one.
7.This was one of those several last resort actions in that case.
 And> the tricuspid annuloplasty, was it "intuitive" or after TEE? 
8.No TEE.I did it because preop TTE showed 1+ Tr and per Hal's advices.> Do
it simple is the first law.
9. IMHO before the turn of the events what I did was the simplest operation
which could be done for him.>
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