[HSF] tricuspid noncoaptation

[erdinç naseri]

Hal, 
To prevent air from being suctioned into the left system and hence the aorta I inserted an epidural catheter into the La and kept LA pressure above 5 mmHg  by adjusting La sump rotation speed.( So there was always  a positive pressure inside the La but not that much to lead to LV subendocardial iinjury).
BTW she started having spontaneous breathing this afternoon. 
erdinc> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] tricuspid noncoaptation> Date: Sun, 17 Feb 2008 17:44:16 -0500> From: hgrmd at aol.com> CC: > > > Erdinc,> >   Now that I've reread your post, I would suspect that your LA sump through the interatrial septum introduced massive air to the left side of the heart during total circulatory arrest.  Most likely, that is the reason your patient never woke up and was found to be seizing.  Did you use C02 in the right chest?  If so, that would reduce the amount of oxygen and nitrogen in the ambient atmosphere.  I've found by using C02 in the right chest for my robotic mitrals, there is virtually no air seen on the left side of the heart by TEE.  If you didn't use C02, it would be essential that a needle vent be inserted in the aorta.  The only way this could have been done would have been by extending the thoracotomy across the sternum or simply making a separate sternotomy.> > > > Hal> > > -----Original Message-----> From: erdinç naseri <enaseri at hotmail.com.tr>> To: openheart-l at lists.hsforum.com> Sent: Sun, 17 Feb 2008 3:02 pm> Subject: RE: [HSF] tricuspid noncoaptation> > > > > > hat was the only option to stop the heart.Aorta out of site ,LV fibrilating.( > o TEE available and can't see LV)> Date: Sat, 16 Feb 2008 00:00:25 +0530> From: > rasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] > ricuspid noncoaptation> CC: > > Erdinc, I am a bit confused. Why did you do a > CA ? You implanted a> valve in the tricuspid position and only vented the left > eart isn't> it ?> Prasanna> > While explanting the valve the cardiac activity > eemed to be> depressed( temp 37,MAP 55, good urination ).VF and several bouts > f> defibrillation gave nothing.Put a LA sump( thru atrial septum) and> cooled > o 20 C. TCA with RCP thru SVC and effluent coming out of> femoral artery with > O2>60% and PO2 >30.Arrest time 28> minutes.Retrograde blood cardioplegia for > nduction ,maintenance and> hot shot. Put 31 MORE bioprosthesis.Annulus somehow > raumatized by> previous sutures but no major problem happened.Deairing from LA > hru> atrial septum.Warming with spontaneous cardiac activity.Weaning with> > notropics .Epicardial echo showed a normal prosthesis with no> regurg.Now at > ostop 14.th hour she is not awakened .She started> having diaphragmatic and > ater on bilateral lower extremity muscular> je> > rks.Diagnosed as seizures and > tarted Epdantoin and diazepam with no response.Pentobarbital was started and > he seizure activity ceased.Venous bloog gas thru reverse L IJV showed PO2 34 > nd SO2 61%.Now the problem is much bigger and again any advice will be > elcomed.> > erdinc> >> >> > _______________________________________________> > > penHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > ttp://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted > y the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > > ttp://www.hsforum.com/listdisclaim> > -----------------------------------------> > > > > > -- > Prasanna Simha M> _______________________________________________> > penHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > > o UNSUBSCRIBE, to CHANGE email address, or to view archives:> > ttp://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by > he OpenHeart-L are subject to the policies and > disclaimers posted at:> > ttp://www.hsforum.com/listdisclaim> -----------------------------------------> ______________________________________________> penHeart-L mailing list> Send postings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/openheart-l> All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at:> ttp://www.hsforum.com/listdisclaim> ----------------------------------------> > > ________________________________________________________________________> More new features than ever. Check out the new AOL Mail ! - http://webmail.aol.com> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------