Year : 2012  |  Volume : 15  |  Issue : 1  |  Page : 92-

Authors' reply


Venugopal Kulkarni, Ravikiran Mudunuri, Krishnaprasad Mulavisala, R Jagannath Byalal 
 Department of Cardiac Anaesthesia, Axon Anaesthesia Associates, Care Hospital, Hyderabad, India

Correspondence Address:
Venugopal Kulkarni
Axon Associates, Care Hospitals, Road No. 1, Banjara Hills, Hyderabad - 500 034
India




How to cite this article:
Kulkarni V, Mudunuri R, Mulavisala K, Byalal R J. Authors' reply.Ann Card Anaesth 2012;15:92-92


How to cite this URL:
Kulkarni V, Mudunuri R, Mulavisala K, Byalal R J. Authors' reply. Ann Card Anaesth [serial online] 2012 [cited 2020 Feb 27 ];15:92-92
Available from: http://www.annals.in/text.asp?2012/15/1/92/91476


Full Text

The Editor,

We thank the authors [1] for their interest on decompression of superior vena cava (SVC) during bidirectional Glenn shunt. [2]

As we have mentioned in the discussion, there is no doubt that direct drainage of the SVC during cardiopulmonary bypass (CPB) is the best means to decompress the SVC. The method we have described will be of help in situations where the drainage has not been established. In our first case the SVC pressures rose after initiation of the anastamosis. The idea of draining the right internal jugular venous canula into the venous reservoir was innovative, which we put into practice and it worked.

With a single lumen canula in the right internal jugular vein one can either decompress or monitor the pressures in the lumen but not do both. While monitoring one cannot actively decompress the SVC and the question of negative pressure at the tip of the canula can at best be assumed but not monitored. To continuously monitor the SVC pressures one would need to insert a double lumen canula or a pressure transducer tipped canula which we believe is not necessary.

We agree with Dr Neema that waking up and movement of limbs is a crude assessment of neurological status, however that remains the best one can do in a small child who has been just extubated in the ICU. The sensitivity of detecting neurological complications following cardiac surgery will no doubt increase with sophisticated intra-operative neurological monitoring, post-operative imaging and developmental assessment. [3]

References

1Neema PK, Manikandan S, Singha S, Rathod RC. Decompression of superior vena cava during bidirectional Glenn shunt: A simple but risky technique. Ann Card Anaesth 2012;15:90-92.
2Kulkarni V, Mudunuri R, Mulavisala KP, Byalal RJ. Decompression of superior venacava during bidirectional Glenn shunt. Ann Card Anaesth 2009;12:146-8.
3Hussain ST, Bhan A Sapra S, Juneja R, Das S, Sharma S. The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option? Interact Cardiovasc Thorac Surg 2007;6:77-82.