Table 1 Etiology and investigation of post CPB ventricular dysfunction
From: An unusual case of cardiac dysfunction after left ventricular reconstruction
| Â | Cause | Investigation | Finding | |
|---|---|---|---|---|
General | Exacerbation of preoperative ventricular dysfunction with relative intolerance to cardioplegic asystolic, hypoxic arrest | Â | TEE | Global or regional wall motion abnormality |
| Â | Reperfusion injury | Â | TEE | Global wall motion abnormality |
| Â | Inadequate myocardial protection (underlying coronary anatomy, route of cardioplegia, type of cardioplegia) | Â | TEE | Global wall motion abnormality |
Case/Patient Specific | Ischemia/infarction | Vessel spasm (native coronaries, internal mammary artery) | ECG, TEE, graft flow | ECG changes, regional wall motion abnormality, poor graft flow |
| Â | Â | Emboli (air, clot, particulate matter) | ECG, TEE, graft flow | ECG changes, regional wall motion abnormality, poor graft flow |
| Â | Â | Technical graft anastomotic tissues | ECG, TEE, graft flow | ECG changes, regional wall motion abnormality, poor graft flow |
| Â | Â | Kink/clotting of bypass grafts, native vessels | ECG, TEE, graft flow, inspection | ECG changes, regional wall motion abnormality, poor graft flow |
| Â | Incomplete revascularization | Non graftable vessels | Â | Â |
| Â | Â | Known intrinsic disease | Â | Â |
| Â | Metabolic | Hypoxia, Hypercarbia | ABG, electrolytes, check ventilation | Â |
| Â | Â | Hypokalemia, hyperkalemia | electrolytes | Â |
| Â | Uncorrected pathology | Hypertrophic cardiomyopathy | TEE | Abnormal outflow gradient, SAM |
| Â | Â | Valve gradients | TEE | Abnormal valve gradient |
| Â | Â | Shunts | TEE | Abnormal Doppler jet |
| Â | Mechanical Issues | Prosthetic valve function | TEE | Poor leaflet motion, abnormal gradient |
| Â | Â | Intracardiac shunt (ASD, VSD) | TEE | Abnormal Doppler jet |
| Â | Conduction Issues | Bradycardia | ECG | Heart rate less than 60 |
| Â | Â | Atrioventricular dissociation | ECG | 3rd degree heart block |
| Â | Â | Atrial Fibrillation | ECG, ABG, electrolytes | Hypoxia, electrolyte abnormality |
| Â | Â | Ventricular arrythmias | ECG, ABG, electrolytes | Hypoxia, electrolyte abnormality |
| Â | Pulmonary hypertension | Preexisting elevated pulmonary pressures, hypoxia, hypercarbia, fluid overload | Swan Ganz monitoring, ABG | Elevated Pulmonary artery pressures, hypoxia, hypercarbia, RV distention |
| Â | Right Ventricular Failure | Elevated pulmonary pressures, inadequate myocardial protection, emboli to native or bypass circulation, fluid overload | Swan Ganz monitoring, ABG, TEE | RV distention, poor RV wall motion, elevated pulmonary artery pressure, elevated central venous pressure |