Re: [HSF] Gengrenous bowels post uneventful CABG

[rwmfglycar at aol.com]

What was unusual about this patient was that he was apparently up and walking around when the gut necrosis became evident.This suggests that a post traumatic hypercoagulable state may hve been part of the problem in a vasculopath who has had many other parts of his cardiovascular system roughed up and perturbed in the previous few days .
One? other fact to remember is that at the flows that some units run the bypass machine the mesenteric flow gets to very low levels. At the commonly used?2.2 L/min/ m2 the patient is in borderline shock.? (There were numerous studies of mesenteric flow during bypass 30-40 years ago).?The patient almost certainly already?had a reduced cardiac output preoperatively. A lowflow nonpulsatile bypass? on top of that could easily?have produced pregangrenous ischemic bowel, especially if he already had mesenteric arterial disease.??Anything extra on top of that can tip the scale.
What I and others are saying is that this was not gangrenous bowel after uneventful cardiac bypass. 

Bob



-----Original Message-----
From: alsadd <alsadd at ksu.edu.sa>
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 6 Jan 2008 11:40 am
Subject: RE: [HSF] Gengrenous? bowels post uneventful? CABG



Thank you I will look it up soon

Ahmed

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of CSPassik at aol.com
Sent: Saturday, January 05, 2008 3:04 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Gengrenous? bowels post uneventful? CABG

There was some old literature on concommitant intrarterial priscoline and 
salvage surgery.   Look up some old papers from Boley, SJ et al dating from
the 
early 1980's. We used to follow this protocol and had what was stated at the

time was the lowest mortality rate from embolic bowel infarction.
Basically, 
an angio catheter was placed by interventional radiology in the SMA and
infused 
priscoline to offset the concomitant spasm that went along with the emboli.

The patient was explored, the SMA embolectomized ,   and the bowel was 
reexamined at 24 hours if I remember correctly.   Sometimes some questinable
bowel   
that initially looked non viable was saved.   I don't think many hospitals 
besides ours(Montefiore in NY)   did this and very few others seem to
remember 
this work. Even if it is too late for this patient it might be worth
thinking 
about when one of our poor patients gets this devastating complication.
Cary Passik


**************
Start the year off right.  Easy ways to stay in 
shape.
     http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489
_______________________________________________
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
-----------------------------------------

_______________________________________________
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
-----------------------------------------


________________________________________________________________________
More new features than ever.  Check out the new AOL Mail ! - http://webmail.aol.com