[HSF] aortic root reimplantation and Rv dysfx-Late answer to ...

[jbflegejr at aol.com]

We use topical ice slush frequently. We have a freezing unit on the 
instrument setup; normal saline is added to the bowl and it is stirred 
while cooling, like when you make ice cream, and the end product is 
like sherbert. A polystryene pad is used in the  pericardium behind and 
lateral to the LV which not lnly affords some protection to the phrenic 
nerve but helps keep the LV from warming from the aortic flow. A gauze 
pad is kept over the RV and a little slush put on it from time to time. 
I suppose that we should measure the myocardial temp but we don't. 
Saline has a lower freezing point than water. The soution around the 
heart is not exactly isotonic but we are not aware of it causing 
hemolysis. As it melts we aspirate the liquid with the waste suction. 
We have not seen phrenic palsy for years but we did have it 
occassionally before we started using the insulating pad. If you do not 
mix the saline during freezing you are apt to end up with frozen water 
and hypertonic liquid. John Flege


-----Original Message-----
From: psimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 10 Sep 2007 8:06 pm
Subject: Re: AW: AW: AW: [HSF] aortic root reimplantation and Rv 
dysfx-Late answer to ...






By ice slush are you using partially frozen ice or ice block which has
been shredded (or hammered) and packed ? There is a difference as the
slush which naturally forms will float up on a layer of water whereas
iice shredded and packed would not melt for a long time. 

Prasanna 

Hgrmd at aol.com wrote: 

> Roberto, 

>   I'm still in the "ice age".  I unapologetically pack the heart  in 
ice upon
> induction.  Periodically, I place ice slush on the right  heart.  I 
use a
> styrofoam insulating sheet alongside the left side of the  
pericardium to protect
> the left phrenic.  I avoid putting ice along the  right side of 
pericardium
> to avoid right phrenic nerve palsy.  During the  terminal phases of 
the clamp,
> I run warm blood down the CS and the grafts.   The overall strategy 
has helped
> me get hearts through greater than 4 hr clamps  with good 
preservation of
> contractility. 

>
> Hal 

> 

> 

> 

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