An ultra-short case report: A patient with severe TVD with LV dysfunction

Rajesh and Team

Department of Cardio Thoracic Vascular Surgery, Kauvery Hospital, Bangalore

Case Presentation

A 69yr aged female had an emergency admission for ACS and LRTI. Cardiac evaluation showed severe, diffusely diseased Triple Vessel Disease (TVD) and LV Dysfunction. She also had CKD and Anemia with Hypoproteinemia.  She was discharged on medical management, but later re-admitted with pulmonary edema.

She was optimized during in-patient admission. Patient showed interest to get operated. After more than a week as In-Patient, she underwent CABG with 3 Vessel Endarterectomy on heart lung machine.

Ventilated overnight, she achieved excellent hemodynamics on just 1ml Noradrenalin.  But she had a Cardiac Arrest next day early morning while on ventilator. CPR was initiated. She received total of 6 cycles of CPR. ROSC (Return of Spontaneous Circulation) was achieved, inotropes maxed out and IABP inserted.

She was started on CVVH (Continuous Veno-Venous Hemofiltration) next day which was continued for 48 hrs. Cardiac function returned to normal and IABP was removed after four days of support. She was gradually weaned off ventilator over next two days and extubated . She had normal cardiac function, on very minimal inotropes.

Conclusion

This case is testimony to the amount of pre op planning and preparation that went into getting her ready for surgery and the intense intra op management that was done. It was a complete team effort.

   Fig (1): Endarterectomy                      Fig (2): TVD on Angiography

 

Kauverian Bookshelf

Applied Medical Statistics

Journals

Kauvery Hospital
Find Doctor
Book Appointment