[HSF] v-feb after AVR+mitral repair+ACB to RCA.

[陈鑫]

 Dear Members:

65 years male with severe AI and mitral regarg ( +++ to ++++), EF 40%, single RCA 80% stenosis, some PVC on EKG,    got AVR+ mitral repair and ACB to RCA last week. He went smoothly during surgery and X'clamp is 85 mins. Off CPB OK, TEE: no mitral regarg, AVR ok.  leave v-pacing wire on just in case ( which is our regular thing for all valve cases). Back to ICU in about 14:00 with Dopo about 4 mic/kg. Wake up in about 18:00 and extubated then.  Everything went fine until about 20:00,  got v-tach and then v-fib. De-dib, back to sinus with stable hemodynemics. Put on Lidocane,  K+ level OK, ABG OK, then v-dib again and again for about 5 to 9 times, then put on Amikedalon ( moy not correct spelling). Check X-ray OK., Check echo both AVR and mitral are ok, with EF 38%. Hemodynemic stable. Urin out put OK.  Be sedated with propfin and be Intubated again. But still many times v-fib, need de-fib for about 20 times in that evening. The next morning, check echo again, everything fine with EF about 40%. Put IABP anyway. V-fib about 5 times during the 1 POD, and 3 times in the evening. Then 2 times in the 2 POD. then fine.  stop sedated and then Extubed in the 4 POD and then  IABP withdrow there after.  Then went well and back to the floor. 

Not sure what cause the v-tech and v-fib. 

Any comments?

Thank you in advance


Steve