title: Utility of pulmonary venous flow diastolic deceleration time in an adult patient undergoing surgical closure of atrial septal defect and coronary artery bypass grafting.
abstract: 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.
authors.affiliation: Consultant Cardiac Anesthesiologist, Fortis Hospitals, Bangalore, India.
authors.forename: Dharmesh R
authors.initials: DR
authors.lastname: Agrawal
authors.forename: Mohammed Rehan
authors.initials: MR
authors.lastname: Sayeed
authors.forename: Murali R
authors.initials: MR
authors.lastname: Chakravarthy
authors.forename: T A
authors.initials: TA
authors.lastname: Patil
mesh_terms: D002637:Chest Pain / Q000209:etiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003971:Diastole; D017548:Echocardiography, Transesophageal; D006324:Heart Arrest, Induced; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D011652:Pulmonary Circulation / Q000502:physiology*; D011667:Pulmonary Veins / Q000502:physiology*; D012121:Respiration, Artificial; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology