This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Couture, P. Articles by Cartier, R. Search for Related Content PubMed PubMed Citation Articles by Couture, P. Articles by Cartier, R.

Partial inferior vena cava snaring to control ischemic left ventricular dysfunction

[Constriction partielle de la veine cave inférieure pour contrôler une dysfonction ventriculaire gauche]

Pierre Couture, MD^*, André Y. Denault, MD^*, Peter Sheridan, MD^*, Stephan Williams, MD PhD^* and Raymond Cartier, MD

^* From the Departments of Anesthesiology, and
Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.

Address correspondence to: Dr. Pierre Couture, Department of Anesthesiology, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330, ext. 3732; Fax: 514-376-8784; E-mail: couture.pierre{at}sympatico.ca

Purpose: To describe the hemodynamic and intraoperative transesophageal echocardiographic evaluation of cardiac systolic and diastolic function in a patient undergoing off-pump coronary artery bypass graft (OP-CABG) surgery who developed pulmonary artery hypertension controlled by inferior vena cava (IVC) snaring.

Clinical features: A 63-yr-old man was referred to our hospital for elective OP-CABG surgery. His preoperative ventriculopathy revealed a decreased systolic function (ejection fraction of 35%), and a mild mitral regurgitation. Intraoperatively, after application of the stabilizer and clamping of the diagonal artery, he developed a marked increase in pulmonary artery pressure (PAP) with a decrease in systemic arterial pressure, non responsive to iv norepinephrine and nitroglycerin. Transesophageal echocardiographic evaluation revealed a marked decrease in systolic function and presence of a restrictive diastolic filling pattern. Partial IVC snaring decreased the venous return and PAP decreased cardiac chamber dimensions, improved systolic function and improved diastolic filling pattern.

Conclusion: Partial IVC snaring was used successfully to treat a hemodynamically unstable patient with sudden increase in PAP caused by ischemic left ventricular failure during OP-CABG.