[HSF] Any One Had This Complication?

[Steven Schwartz]

Hal,
Very interesting timing. I did an aortic root replacement (27mm SJM  
with valsalva graft), coronary reimplantation and RIMA-RCA for 80%  
proximal RCA stenosis in a 65 yo man WITHOUT history of significant  
vascular disease (and good distal pulses on exam). He had two bloody  
stools the evening after surgery, but only a mild metabolic acidosis.  
The following morning, hemodynamics were stable, but CK was about  
5000, with very little MB fraction. GI medicine has seen him, his  
abdomen in non-tender, and he seems to be resolving what we think was  
a transient bowel ischemia. Pump flows were >5 l/m, he had no acidosis  
during the pump run, but was significantly vasodilated during and  
after bypass (requiring vasopressin infusion to keep his BP > 50  
mmHg). He was on 320mg of Diovan in addition to beta blockers preop.
Any thoughts?
Steven Schwartz

On Apr 27, 2008, at 5:49 AM, 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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Steven M. Schwartz, MD
smschwartz at mac.com