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Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting


1 Consultant Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India
2 Consultant Cardiac Surgeon, Fortis Hospitals, Bangalore, India
3 Chief Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India
4 Senior Consultant Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India

Correspondence Address:
Dharmesh R Agrawal
Fortis Hospital, Cunningham Road, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.105369

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Year : 2013  |  Volume : 16  |  Issue : 1  |  Page : 44-46

 

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Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.






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1 Consultant Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India
2 Consultant Cardiac Surgeon, Fortis Hospitals, Bangalore, India
3 Chief Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India
4 Senior Consultant Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India

Correspondence Address:
Dharmesh R Agrawal
Fortis Hospital, Cunningham Road, Bangalore
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.105369

Rights and Permissions

Acute left ventricular (LV) failure has been reported after surgical closure of atrial septal defect (ASD) in adult patients. We report acute LV failure in a 56 year old gentleman following coronary artery bypass grafting (CABG) and surgical closure of ASD. Transesophageal echocardiography examination of the patient following closure of ASD and CABG showed a residual ASD and a shunt (Qp :Qs = 1.5). The residual ASD was closed after re-institution of cardiopulmonary bypass (CPB) under cardioplegic cardiac arrest. However, the patient did not tolerate closure of the residual ASD. The CPB was re-established and under cardioplegic cardiac arrest residual ASD was reopened to create a fenestration. This time patient was weaned easily from CPB. Postoperatively, 16 hours after extubation, patient became hemodynamically unstable, the patient was electively put on ventilator and intra-aortic balloon pump. Later the patient was weaned off successfully from ventilator. Retrospective analysis of pulmonary venous flow diastolic deceleration time (PVDT D ) recorded during prebypass period measured 102 msec suggestive of high left atrial pressure which indicate possibility of LV failure after ASD closure.






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