[HSF] Bentall + CABG

[erdinç naseri]

Dear Zou,
No TEE perop.He deteriorated one hour ago with severe metabolic acidosis( Lactic acidosis) and complete loss of consciousness.Intubated and bicarbonate infusion.( LA down from >15 to 9.1 and PH 7.01 to 7.24 and finaly 7.31) He is not septic but AST and ALT increased by more than 400 in a matter of hours).Doppler USG showed  a completely patent portal vein and hepatic artery.No sign of bowel ischemia on abd USG.BTW he is diabetic and BGL was 341 at the onset of deterioration which decreased to 150 by appropriate measures.
erdin
> From: zzhoumd at pol.net> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Bentall + CABG> Date: Tue, 8 Jan 2008 19:26:59 +0800> CC: > > Erdinc:> > Did he have TEE during surgery?> > Subcutaneous emphysema itself is usually benign and self limited. If he is still septic with mediastinal air, check if he has esophageal perforation. We had patient like this had esophageal perforation from trans-esophageal echocardiogram which presented like this.> > Good luck!> > Zhandong Zhou > > > > ----- Original Message ----- > From: "erdinç naseri" <enaseri at hotmail.com.tr>> To: <openheart-l at lists.hsforum.com>> Sent: Wednesday, January 09, 2008 4:59 AM> Subject: [HSF] Bentall + CABG> > > > > > Urgent opinion requested about the following case:> > 62 Y/O male underwent Bentall operation and CABG X 2 .At postop 10.th hour he underwent sternal reopening due to tamponade.Transferred to normal ward at postop 2.nd day.At postop 7.th day developed wide spread subcutaneous emphysema all over the chest . He was satble with no pneumothorax on CRX. No intervention.At postop 8.th day he was noticed to have lower sternal dehiscence with disruption of the skin sutures at lower end of the incision.Conservative wound dressing proved useful.He had 2 bouts of fever>38. Wbc 7000 Pmn 90%.Sedinentaion 55 mm/hr.Cipro + Rocephin + amikacin started .Thoracic CT showed air in mediastinum and minimal perigraft fluid collection.He has been on cipro, rocephin and amikacin for the last 7 days ( empiric application). Today he had several bouts of vomiting . Consultaion with general surgeon proved no intestinal obstruction. On evening he had Diazepam 5 mgr im. one hour later he developed motor and sensory dysphasia with facial and lingual tremor> > .Cranial Ct normal.İncidental biochemistry showed ALT 990 and AST 1500. INR 2.03 ( on coumadin till today) .> > 1. Is the mediastinal air due to pulmonar air leak ( related to subcutaneous emphysema) or graft infection.> > 2.Is elevated HFT due to hypopefusion during CPB( somehow late occurance)> > erdinc> > > > _______________________________________________> > 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> > -----------------------------------------