Re: [½ðɽ¶¾°Ôʶ±ð´ËÓʼþΪÀ¬»øÓʼþ]Re: [HSF] v-feb after AVR+mitral repair+ACB to RCA.

[陈鑫]

Ben:

Yes, his only RCA about 80%stenosis, and did a SV to RCA with perfect graft flow.  I don't  think his LMCA was damaged for we had a exposure during AVR.  K+ is OK. 

He is doing fine now. 

THank you for your comments. Will you have chance to visit China? Let me know when you have please. 

Steve

----- Original Message ----- 
From: "Ben Bidstrup" <benjamin.bidstrup at bigpond.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Tuesday, January 08, 2008 7:36 AM
Subject: [½ðɽ¶¾°Ôʶ±ð´ËÓʼþΪÀ¬»øÓʼþ]Re: [HSF] v-feb after AVR+mitral repair+ACB to RCA.


> Steve,
> Have you done a coronary angio?
>  Several possibilities. Damage  to circumflex, RCA graft not right. 
> Any possibility of compromise of LMCA orifice by AV prosthesis?
> 
> What about electrolytes? K OK?
> 
>>  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
>>
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> 
> 
> -- 
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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