title: A patent ductus arteriosus complicating cardiopulmonary bypass for combined coronary artery bypass grafting and aortic valve replacement only discovered by computed tomography 3D reconstruction.
abstract: We describe the case of a 59-year old male patient undergoing combined coronary artery bypass grafting and aortic valve replacement. Manipulation of the heart during cardiopulmonary bypass significantly decreased venous return. Several measures were necessary to improve venous return to a level at which continuation of the procedure was safe. Based on the initial troubles with venous return, we decided to selectively cross-clamp the aorta. This resulted in a large amount of backflow of oxygenated blood from the left ventricle, necessitating additional vents in the pulmonary artery and directly in the left ventricle. The procedure was continued uneventfully, and postoperative recovery was without significant complications. Postoperative 2D computed tomography did not show any signs of a shunt, but 3D reconstruction showed a small patent ductus arteriosus.
authors.affiliation: Department of CardioThoracic Surgery, Maastricht University Medical Centre, Maastricht, Limburg, Netherlands l.vanmiddendorp@maastrichtuniversity.nl.
authors.forename: Lars B
authors.initials: LB
authors.lastname: van Middendorp
authors.affiliation: Department of CardioThoracic Surgery, Maastricht University Medical Centre, Maastricht, Limburg, Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
authors.affiliation: Department of CardioThoracic Surgery, Maastricht University Medical Centre, Maastricht, Limburg, Netherlands.
authors.forename: Peyman
authors.initials: P
authors.lastname: Sardari Nia
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: 3D computed tomography scan; Aortic valve replacement; Cardiopulmonary bypass; Coronary artery bypass grafting; Left-to-right shunt; Patent ductus arteriosus