Partial inferior vena cava snaring to control ischemic left ventricular dysfunction.
OBJECTIVE
To describe the hemodynamic and intraoperative transesophageal echocardiographic evaluation of cardiac systolic and diastolic function in a patient undergoing off-pump coronary artery bypass graft (OP-CABG) surgery who developed pulmonary artery hypertension controlled by inferior vena cava (IVC) snaring.


METHODS
A 63-yr-old man was referred to our hospital for elective OP-CABG surgery. His preoperative ventriculopathy revealed a decreased systolic function (ejection fraction of 35%), and a mild mitral regurgitation. Intraoperatively, after application of the stabilizer and clamping of the diagonal artery, he developed a marked increase in pulmonary artery pressure (PAP) with a decrease in systemic arterial pressure, non responsive to iv norepinephrine and nitroglycerin. Transesophageal echocardiographic evaluation revealed a marked decrease in systolic function and presence of a restrictive diastolic filling pattern. Partial IVC snaring decreased the venous return and PAP decreased cardiac chamber dimensions, improved systolic function and improved diastolic filling pattern.


CONCLUSIONS
Partial IVC snaring was used successfully to treat a hemodynamically unstable patient with sudden increase in PAP caused by ischemic left ventricular failure during OP-CABG.
Couture
Pierre
P
Department of Anesthesiology, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Quebec H1T 1C8, Canada. couture.pierre@sympatico.ca
Denault
André Y
AY
Sheridan
Peter
P
Williams
Stephan
S
Cartier
Raymond
R
D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003326:Coronary Circulation / Q000502:physiology; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D011651:Pulmonary Artery / Q000503:physiopathology; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000601:surgery*