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Table 1 Etiology and investigation of post CPB ventricular dysfunction

From: An unusual case of cardiac dysfunction after left ventricular reconstruction

  Cause Investigation Finding
General Exacerbation of preoperative ventricular dysfunction with relative intolerance to cardioplegic asystolic, hypoxic arrest   TEE Global or regional wall motion abnormality
  Reperfusion injury   TEE Global wall motion abnormality
  Inadequate myocardial protection (underlying coronary anatomy, route of cardioplegia, type of cardioplegia)   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
   Emboli (air, clot, particulate matter) ECG, TEE, graft flow ECG changes, regional wall motion abnormality, poor graft flow
   Technical graft anastomotic tissues ECG, TEE, graft flow ECG changes, regional wall motion abnormality, poor graft flow
   Kink/clotting of bypass grafts, native vessels ECG, TEE, graft flow, inspection ECG changes, regional wall motion abnormality, poor graft flow
  Incomplete revascularization Non graftable vessels   
   Known intrinsic disease   
  Metabolic Hypoxia, Hypercarbia ABG, electrolytes, check ventilation  
   Hypokalemia, hyperkalemia electrolytes  
  Uncorrected pathology Hypertrophic cardiomyopathy TEE Abnormal outflow gradient, SAM
   Valve gradients TEE Abnormal valve gradient
   Shunts TEE Abnormal Doppler jet
  Mechanical Issues Prosthetic valve function TEE Poor leaflet motion, abnormal gradient
   Intracardiac shunt (ASD, VSD) TEE Abnormal Doppler jet
  Conduction Issues Bradycardia ECG Heart rate less than 60
   Atrioventricular dissociation ECG 3rd degree heart block
   Atrial Fibrillation ECG, ABG, electrolytes Hypoxia, electrolyte abnormality
   Ventricular arrythmias ECG, ABG, electrolytes Hypoxia, electrolyte abnormality
  Pulmonary hypertension Preexisting elevated pulmonary pressures, hypoxia, hypercarbia, fluid overload Swan Ganz monitoring, ABG Elevated Pulmonary artery pressures, hypoxia, hypercarbia, RV distention
  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
  1. ABG = arterial blood gas, ECG = electrocardiogram, RV = right ventricle, SAM = systolic anterior motion of mitral valve leaflet, TEE = Tranesophageal echocardiogram