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STONE HEART SYNDROME

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lavanyasekhar View Drop Down
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Joined: Nov 21 2007
Location: India
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Posts: 6
  Quote lavanyasekhar Quote  Post ReplyReply bullet Topic: STONE HEART SYNDROME
    Posted: Dec 19 2007 at 1:29am

THIS IS CASE OF AN 18 DAY OLD BABY WEIGHING 2.5KG POSTED FOR ARTERIAL SWITCH . THE DIAGNOSIS WAS TGA WITH l MALPOSED GREAT ARTERIES, 2 VSD'S. PFO. AFTER OPENING THEY DECIDED TO DO A SENNIGNS OPERATION . THE PLAN WAS TO PERFORM A CIRCULATORY ARREST .SO THE PATIENT WAS COOLED TO 22 DEGREES AND THE FIRST DOSE CARDIOPLEGIA WAS GIVEN . IT WAS A BLOOD CARDIOPLEGIA GIVEN THROUGH THE 1:4 BCD SYSTEM AT A TEMPERATURE OF 4 DEGREES AND THE DELIVERY PRESSURE WAS 100-120mmHg.AFTER 56 MINUTES OF 1ST DOSE ,2ND DOSE OF CARDIOPLEGIA WAS DELIVERED AT 19.6 DEGREES WITH THE CP TEMPERATURE OF 4 DEGREES WITH A INFUSION PRESSURE OF 120 - 140 mmHg AT THE PUMP RATE OF 50-60ML/MIN FOR 3 MINUTES. DURING THE CARDIOPLEGIA INFUSION THE HEART BECAME CONTRACTED AND RIGID.FOLLOWING THAT CIRCULATORY ARREST WAS PERFORMED FOR 46 MINUTES.WHILE REWARMING THE FIRST BLOOD GAS ANALYSIS SHOWED A POTASSIUM OF 9.6 mg/dl . HEMOFILTERATION WAS DONE AND 4UNITS OF INSULIN WAS GIVEN. BY THE TIME TEMPERATURE REACHED 35 DEGREES THE POTASSIUM LEVEL CAME TO 3.3mg/dl AND THE HEART SIZE CAME TO NORMAL, BUT LOST ITS CONTRACTILITY. THE PATIENT COULD NOT BE WEANED OF BYPASS.  

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Lenin Shanmugam View Drop Down
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Joined: Aug 13 2007
Location: Canada
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Posts: 4
  Quote Lenin Shanmugam Quote  Post ReplyReply bullet Posted: Jan 14 2008 at 6:12pm
Hi,
This phenomenon is rarely discussed I think.  I had just one experience with an infant which occured within 2-3 minutes after going on bypass, before aortic cross clamp.  We suspected high calcium but on ABG showed normal.  The insult was unknown and we failed to revive the case.  The heart was getting so stiff that it was impossible for the surgeons to massage and finally they gave up.

However, I discussed this issue with one of my friend in US and he said he also had just one experience but it was successful with the pacemaker to go on later.

His statement was it was also a pediatric case, active students around.  Calcium chloride was added twice due to poor communication and this scenario happened.  Fortunately this was on rewarming stage and the cross clamp in position.  The heart was perfused with continuous  warm blood for over 30 minutes and the heart started beating with some disturbances due to which they had to go on pacemaker.  It was a successful recovery.

Lenin
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