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Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis
- Source :
- Journal of Anesthesia. 25:263-266
- Publication Year :
- 2011
- Publisher :
- Springer Science and Business Media LLC, 2011.
-
Abstract
- We report a case of an adult male who had received a gunshot to the abdomen 12 years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF). Following endovascular repair of the ACF, we observed an immediate rise in systemic vascular resistance (SVR), decrease in central venous pressure (CVP), increase in regurgitant flow across the aortic valve, and decrease in central mixed venous oxygenation. A combination of vasodilators and vasopressors was used to maintain hemodynamics. Milrinone infusion was necessary after cardiopulmonary bypass to maintain cardiac output. Even though local anesthesia and light sedation were used for ACF closure, the hemodynamics changed dramatically throughout the procedure. ACF closure under local anesthesia and sedation is preferred because the hemodynamics alterations under local anesthesia are less severe. The rise in SVR and regurgitant flow across aortic valve is less dramatic. As a result, hemodynamic management and separation from cardiopulmonary bypass are easier.
- Subjects :
- Male
Aortic valve
medicine.medical_specialty
Central Venous Pressure
Aortic Valve Insufficiency
Aortic Diseases
Hemodynamics
Vena Cava, Inferior
Regurgitation (circulation)
law.invention
Aortic valve replacement
law
Internal medicine
medicine
Cardiopulmonary bypass
Humans
Anesthesia
Local anesthesia
Heart Valve Prosthesis Implantation
business.industry
Central venous pressure
Endocarditis, Bacterial
Middle Aged
medicine.disease
digestive system diseases
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Aortic Valve
Arteriovenous Fistula
Vascular resistance
Cardiology
Vascular Resistance
business
Subjects
Details
- ISSN :
- 14388359 and 09138668
- Volume :
- 25
- Database :
- OpenAIRE
- Journal :
- Journal of Anesthesia
- Accession number :
- edsair.doi.dedup.....92855fe5b9ff9a9ed6748926e9686611