Cardiopulmonary bypass is typically required for coronary artery bypass surgery, valve repair or replacement, congenital heart defect correction and cardiovascular operation. However, difficulty in weaning from cardiopulmonary bypass can increase mortality, which makes difficulties for the physicians. The cause of difficult weaning should be found, but sometimes it is difficult. The assessment by transesophageal echocardiography plays a central role in diagnosing and managing the cardiac operations patients. The early principal goal is the assessment of any findings that indicate a structural problem, which may require immediate surgical intervention. Herein, we presented a case of difficulty in weaning from cardiopulmonary bypass. A 53-year-old woman was admitted to our hospital due to fatigue and lower limb edema. The patient planned to undergo tricuspid bioprosthetic valve replacement under cardiopulmonary bypass due to the dysfunction of the tricuspid mechanical valve and the anticoagulant drugs being ineffective. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. Abnormal tricuspid regurgitation displayed by transesophageal echocardiography. After reopening the right atrium for testing, it was found that the mitral valve was occluded by gauze. Removing the gauze from the right atrium, it was successfully separated from cardiopulmonary bypass. Transesophageal echocardiography is important to accurately understand the clinical course of such complications.
| Published in | International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 2) |
| DOI | 10.11648/j.ijacm.20231102.14 |
| Page(s) | 72-75 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Cardiopulmonary Bypass, Transesophageal Echocardiography, Tricuspid Valve
| [1] | Ailawadi G, Zacour RK. Cardiopulmonary bypass/extracorporeal membrane oxygenation/left heart bypass: indications, techniques, and complication. Surg Clin North Am 2009; 89 (4): 781-796, vii-viii. |
| [2] | Denault AY, Tardif JC, Mazer CD, et al. Difficult and complex separation from cardiopulmonary bypass in high-risk cardiac surgical patients: a multicenter study. J Cardiothorac Vasc Anesth 2012; 26 (4): 608-616. |
| [3] | Salis S, Mazzanti VV, Merli G, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22 (6): 814-822. |
| [4] | Doenst T, Wijeysundera D, Karkouti K, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2005; 130 (4): 1144. |
| [5] | Lee AP, Lam YY, Yip GW, et al. Role of real time three-dimensional TEE in guidance of interventional procedures in cardiology. Heart 2010; 96 (18): 1485-1493. |
| [6] | Orvalho JS. Real-time Three-dimensional Echocardiography: From Diagnosis to Intervention. Vet Clin North Am Small Anim Pract 2017; 47 (5): 1005-1019. |
| [7] | Fan Y, Chan JSK, Lee AP. Advances in Procedural Echocardiographic Imaging in Transcatheter Edge-to-Edge Repair for Mitral Regurgitation. Front Cardiovasc Med 2022; 9: 864341. |
| [8] | El-Eshmawi A, Pandis D, Adams DH, et al. Tricuspid valve surgery: repair and replacement. Minerva Cardioangiol 2018; 66 (6): 700-712. |
| [9] | Dreyfus J, Dreyfus GD, Taramasso M. Tricuspid valve replacement: The old and the new. Prog Cardiovasc Dis 2022; 72: 102-113. |
| [10] | Practice guidelines for perioperative TEE. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on TEE. Anesthesiology 2010; 112 (5): 1084-1096. |
| [11] | Flachskampf FA, Badano L, Daniel WG, et al. Recommendations for transoesophageal echocardiography: update 2010. Eur J Echocardiogr 2010; 11 (7): 557-576. |
| [12] | Win TT, Alomari IB, Awad K, et al. Transesophageal Versus Transthoracic Echocardiography for Assessment of Left Ventricular Diastolic Function. J Integr Cardiol Open Access 2020; 3 (1). |
| [13] | Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of, Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17 (4): 412. |
| [14] | Puchalski MD, Lui GK, Miller-Hance WC, et al. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic: Examination in Children and All Patients with Congenital Heart Disease: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019; 32 (2): 173-215. |
| [15] | Liu H, Yu L, Yang L, et al. Vasoplegic syndrome: An update on perioperative considerations. J Clin Anesth 2017; 40: 63-71. |
| [16] | Busse LW, Barker N, Petersen C. Vasoplegic syndrome following cardiothoracic surgery-review of pathophysiology and update of treatment options. Crit Care 2020; 24 (1): 36. |
| [17] | Sangkum L, Liu GL, Yu L, et al. Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth 2016; 30 (3): 461-480. |
| [18] | Arya VK, Al-Moustadi W, Dutta V. Cardiac output monitoring - invasive and noninvasive. Curr Opin Crit Care 2022; 28 (3): 340-347. |
APA Style
Min Xu, Meng Dai, Xuejie Li, Xiao Wang. (2023). An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass. International Journal of Anesthesia and Clinical Medicine, 11(2), 72-75. https://doi.org/10.11648/j.ijacm.20231102.14
ACS Style
Min Xu; Meng Dai; Xuejie Li; Xiao Wang. An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass. Int. J. Anesth. Clin. Med. 2023, 11(2), 72-75. doi: 10.11648/j.ijacm.20231102.14
AMA Style
Min Xu, Meng Dai, Xuejie Li, Xiao Wang. An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass. Int J Anesth Clin Med. 2023;11(2):72-75. doi: 10.11648/j.ijacm.20231102.14
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijacm.20231102.14,
author = {Min Xu and Meng Dai and Xuejie Li and Xiao Wang},
title = {An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass},
journal = {International Journal of Anesthesia and Clinical Medicine},
volume = {11},
number = {2},
pages = {72-75},
doi = {10.11648/j.ijacm.20231102.14},
url = {https://doi.org/10.11648/j.ijacm.20231102.14},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231102.14},
abstract = {Cardiopulmonary bypass is typically required for coronary artery bypass surgery, valve repair or replacement, congenital heart defect correction and cardiovascular operation. However, difficulty in weaning from cardiopulmonary bypass can increase mortality, which makes difficulties for the physicians. The cause of difficult weaning should be found, but sometimes it is difficult. The assessment by transesophageal echocardiography plays a central role in diagnosing and managing the cardiac operations patients. The early principal goal is the assessment of any findings that indicate a structural problem, which may require immediate surgical intervention. Herein, we presented a case of difficulty in weaning from cardiopulmonary bypass. A 53-year-old woman was admitted to our hospital due to fatigue and lower limb edema. The patient planned to undergo tricuspid bioprosthetic valve replacement under cardiopulmonary bypass due to the dysfunction of the tricuspid mechanical valve and the anticoagulant drugs being ineffective. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. Abnormal tricuspid regurgitation displayed by transesophageal echocardiography. After reopening the right atrium for testing, it was found that the mitral valve was occluded by gauze. Removing the gauze from the right atrium, it was successfully separated from cardiopulmonary bypass. Transesophageal echocardiography is important to accurately understand the clinical course of such complications.},
year = {2023}
}
TY - JOUR T1 - An Unexpected Case of Difficulty in Weaning from Cardiopulmonary Bypass AU - Min Xu AU - Meng Dai AU - Xuejie Li AU - Xiao Wang Y1 - 2023/08/05 PY - 2023 N1 - https://doi.org/10.11648/j.ijacm.20231102.14 DO - 10.11648/j.ijacm.20231102.14 T2 - International Journal of Anesthesia and Clinical Medicine JF - International Journal of Anesthesia and Clinical Medicine JO - International Journal of Anesthesia and Clinical Medicine SP - 72 EP - 75 PB - Science Publishing Group SN - 2997-2698 UR - https://doi.org/10.11648/j.ijacm.20231102.14 AB - Cardiopulmonary bypass is typically required for coronary artery bypass surgery, valve repair or replacement, congenital heart defect correction and cardiovascular operation. However, difficulty in weaning from cardiopulmonary bypass can increase mortality, which makes difficulties for the physicians. The cause of difficult weaning should be found, but sometimes it is difficult. The assessment by transesophageal echocardiography plays a central role in diagnosing and managing the cardiac operations patients. The early principal goal is the assessment of any findings that indicate a structural problem, which may require immediate surgical intervention. Herein, we presented a case of difficulty in weaning from cardiopulmonary bypass. A 53-year-old woman was admitted to our hospital due to fatigue and lower limb edema. The patient planned to undergo tricuspid bioprosthetic valve replacement under cardiopulmonary bypass due to the dysfunction of the tricuspid mechanical valve and the anticoagulant drugs being ineffective. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. Abnormal tricuspid regurgitation displayed by transesophageal echocardiography. After reopening the right atrium for testing, it was found that the mitral valve was occluded by gauze. Removing the gauze from the right atrium, it was successfully separated from cardiopulmonary bypass. Transesophageal echocardiography is important to accurately understand the clinical course of such complications. VL - 11 IS - 2 ER -
Information
Email: