Document Detail


Excellent outcomes in a case of complex re-do surgery requiring prolonged cardioplegia using a new cardioprotective approach: adenocaine.
MedLine Citation:
PMID:  18853834     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 71-year-old high-risk fourth-time redo male patient was diagnosed with prosthetic valve endocarditis of both aortic and mitral valves, and subsequently required a re-operative aortic and mitral valve replacement. He was placed on cardiopulmonary bypass (CPB) and arrested with normothermic hyperkalemic all-blood cardioplegia (microplegia) containing adjunctive adenosine-lidocaine-magnesium (adenocaine); aerobic arrest was maintained with near-continuous retrograde low potassium (approximately 2 mEq/L) adenocaine microplegia. After 4 hours of arrest on CPB, the aortic valve was found to be incompetent and was resected. A root replacement was required utilizing a Medtronic Freestyle Root prosthesis. Four separate periods of cross-clamp were required during the course of the entire operation. The patient was on CPB for 9.8 hours with a total cross-clamp time of 7 hours, during which he received 72 liters of all-blood adenocaine microplegia. After a terminal "hot shot" with adenocaine microplegia and no added potassium, CPB was discontinued with no systemic hyperkalemia (5.1 mmol/L), no hemodilution (hematocrit, 24%), no balloon pump, no antiarrhythmic agents, and modest inotropic support. The patient was hemodynamically stable, was extubated in 12 hours, and was transferred out of the cardiac ICU after 48 hours with a subsequent uneventful recovery.
Authors:
James J O'Rullian; Stephen E Clayson; Raul Peragallo
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of extra-corporeal technology     Volume:  40     ISSN:  0022-1058     ISO Abbreviation:  J Extra Corpor Technol     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-10-15     Completed Date:  2008-11-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267637     Medline TA:  J Extra Corpor Technol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  203-5     Citation Subset:  T    
Affiliation:
The Department of Cardiac Perfusion, Intermountain Medical Center, 5121 South Cottonwood Street, Murray, UT 84157, USA. jorullian@comcast.net
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MeSH Terms
Descriptor/Qualifier:
Adenosine / administration & dosage
Aged
Cardiopulmonary Bypass / methods*
Cardiotonic Agents / administration & dosage*
Cardiovascular Surgical Procedures / adverse effects*,  methods*
Drug Therapy, Combination
Humans
Hyperkalemia / etiology,  prevention & control*
Lidocaine / administration & dosage
Magnesium / administration & dosage
Male
Middle Aged
Reoperation / adverse effects,  methods
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 137-58-6/Lidocaine; 58-61-7/Adenosine; 7439-95-4/Magnesium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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