[HSF] Any One Had This Complication?

[Prasanna Simha M]

Hal he has mesenteric Ischemia. I have seen this in a couple of cases and in
fact if you remember I posted a couple of pictures some time back. How is
his lower gut being supplied after graft excision. If there is a knowledge
of this then hooking up a catheter and mesenteric artery perfusion with
papaverine or NTG could be helpful and may be life saving. Remember that gut
may not be frankly necrotic but can allow translocation of gut endotoxinn
that can be detrimental so acting now could be important to prevent massive
gut necrosis. Incidentally check for HIT.
Can you please give us details of gut arterial supply.
Prasanna
On Sun, Apr 27, 2008 at 6:19 PM, <Hgrmd at aol.com> wrote:

> Dear Members,
>  Last Friday was a tough day at the office.  First I did a  mitral,
> tricuspid, Cox-maze, CABG x1 on a 72 yo lady.  I then did an AVR,  MVR
> (heavily
> calcified posterior annulus), tricuspid, CABG x 4, Cox-maze on a 78  yo
> man.  His
> past history was notable for the fact that he had an  aorto-enteric
> fistula
> (previous AAA repair) requiring excision of the graft and  a right
> axillary-bifemoral bypass.  Intraop, I noticed that the LIMA had
>  unusually brisk flow.
> About 4 hours postop, he had a bright red  stool.  NG aspirate nonbloody.
>  By
> yesterday afternoon, he had begun  to develop abdominal tenderness.  He
> had a lap
> in the early evening.   There was a dead colon requiring resection.  The
> small
> bowel reportedly  looked ischemic, but viable.  He's much better this
> morning, though he's  now developed ATN.  His heart is working great.
>  It'll be a
> struggle,  but I'm cautiously optimistic he'll make it.  Anybody seen this
> scenario?
>
> Hal
>
>
>
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-- 
Prasanna Simha M