THROWN TO THE WOLVES

1
THROWN TO THE WOLVES

• INCE, PARDO ET. AL.

2
PRE-OPERATIVE EVAL

• 31 Y.O. G1 P0 WITH HX OF SYMPTOMATIC Aortic
  Stenosis (Bicuspid Aortic Valve)
• 18 WKS PREGNANT
• S/F AORTIC VALVULOPLSTY IN CATH LAB

3

• STANDARD ASA MONITORS
• 20G R RADIAL ARTERIAL LINE
• TEE ( DONE BY CARDIOLOGIST)
• INDUCED WITH STP/ROC/FENT
• MAINTENANCE OF ANESTHESIA WITH SEVOFLURANE
• REQUIRES MILD BP SUPPORT WITH PHENYLEPHRINE IN
  BLOUS DOSES

4

• SURGICAL PROCEDURE STARTS
• FIRST BALLOON ANGIOPLASTY ATTEMPT UNSUCCESSFUL
• SECOND ATTEMPT MADE
• BP DROPS FROM 110/60 TO 80/55
• BP RESPONDS PROMPTLY TO PHENYLEPHRINE 100 MCG

5

• THIRD ANGIOPLASTY ATTEMPT ALSO UNSUCCESSFUL
• BP DROPS FROM 100/65 TO 65/45
• HR INCREASES FROM 75 TO 110
• EPINEPRINE 700 MCG GIVEN ALONG WITH FLUID BOLUS
• PROMPT RESPONSE IN BP

6

• INCREASED PERICARDIAL FLUID NOTED ON TEE
• DOPAMINE INFUSION STARTED
• ALBUMIN, PRBCS ADMINISTERED
• PERICARDIOCENTESIS PERFORMED, FRANK BLOOD
  ASPIRATED
• CT SURGEON PAGED, AND PERICARDIAL WINDOW PERFORMED

7

• PTS PAP INCREASING DURING THIS TIME
• PINK, FROTHY FLUID ASPIRATED FROM ETT
• PT SWITCHED TO SIEMENS VENTILATOR AND LASIX 20MG
  GIVEN

8
CONCLUSION OF CASE

• PATIENT TRANSFERRED TO ICU INTUBATED
• SEDATED WITH VERSED
• RESCHEDULED TO OR FOR FORMAL REPLACEMENT OF AV