[HSF] Any One Had This Complication?

[Prasanna Simha M]

The case refers to a patient who had massive gut necrosis after vasopressin
therapy.I had presented it to the forum  a few years back with photographs.
I had done a laparotomy for this patient and found a lot of dead bowel.(The
initial suspicion was embolism).Vasopressin is well known to cause gut
Ischemia  as it causes portal vasoconstriction in high doses (It actually
improves renal perfusion by causing efferent arterial vasoconstriction at
lower doses and thus increasing GFR). I had a mesentric angio done and the
patient showed mesentric spasm and required intrarterial papaverine and a
second look operation.
Prasanna

On Mon, Apr 28, 2008 at 7:40 AM, <fhcheema at hotmail.com> wrote:

> Dr. Simha:
> Can you please elaborate a bit further on your vasopressin theory?
> Also, which specific case were you referring to?
> Sincerely,
> Faisal
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Prasanna Simha M" <prasannasimha at gmail.com>
>
> Date: Mon, 28 Apr 2008 07:03:38
> To:OpenHeart-L at lists.hsforum.com <To%3AOpenHeart-L at lists.hsforum.com>
> Subject: Re: [HSF] Any One Had This Complication?
>
>
> Steve, Vasopressin can cause this.In fact it was the suspected culprit in
> one of the cases.
> What is Diovan ?
> Prasanna
>
> On Mon, Apr 28, 2008 at 4:41 AM, Steven Schwartz <smschwartz at mac.com>
> wrote:
>
> > 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
> > >
> > >
> > >
> > > **************Need a new ride? Check out the largest site for U.S.
> used
> > > car
> > > listings at AOL Autos.
> > > (http://autos.aol.com/used?NCID=aolcmp00300000002851)
> > > _______________________________________________
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> >
> > Steven M. Schwartz, MD
> > smschwartz at mac.com
> >
> >
> >
> >
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>
> --
> Prasanna Simha M
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-- 
Prasanna Simha M