The Real History Behind The RepSox Success
The mean pulmonary artery (PA) pressure was 12?mmHg as measured in the main pulmonary artery trunk. An 18?��?40?mm Atlas PTA balloon (BARD peripheral vascular Inc, AZ, USA) was then positioned across the pulmonary valve and a balloon dilatation was done. Waist produced by stenotic valve was obliterated and valve opened well (Fig.?1). Post procedure the RV systolic pressure decreased to 90?mmHg and the PA pressure increased to 77/30?mmHg with a mean pressure of 56?mmHg (Fig.?2). Repeat right ventriculogram done showed that the valve had opened well with mild pulmonary insufficiency. The PA pressures however continued to remain high even after 10?min of the procedure. The patient remained hemodynamically stable with the oxygen saturation increasing to 100%. Fig.?1 A Shows a waist over the balloon during BPV; B Fully dilated balloon. The balloon size was 18?��?40?mm. Fig.?2 RV and PA pressure tracings during the procedure. The scale is of 100?mmHg. buy PF-562271 A Shows the RV pressure at baseline before BPV; B RV pressure tracing after BPV; C PA pressure before BPV; D PA pressure after BPV shows significant rise which was persistent. ... The patient was shifted to the post cath recovery room for monitoring and close observation. 20?min after the procedure, the patient complained of sudden onset of breathlessness with associated cough. The oxygen saturation started dropping and within 5?min dropped to 55%. The patient was visibly cyanosed and chest auscultation revealed B/L diffuse coarse crepitations RepSox with Fluvoxamine wheezes. At this stage the patient started having profuse hemoptysis with blood stained frothy sputum. She was given intravenous (IV) Frusemide and was immediately intubated and put on ventilator support. The blood pressure remained normal. An echo was done immediately which showed a peak PA gradient of 30?mmHg. Other findings by echo were normal as noted in the pre BPV echo. The patient continued to have profuse bloody frothy sputum from the endotracheal tube and the PEEP in the ventilator setting had to be increased to 18?mmHg to maintain a saturation of 90% with 100% oxygen. The blood pressure continued to be normal. 6?h after the procedure the patient started developing hypotension. IV Ionotropes were started and she was eventually on the highest possible dose of Dopamine and Noradrenaline infusion. Her blood pressure however kept falling and the hourly urine output fell down to 30?ml per hour over the next 3?hours. Nine hour after the procedure the patient had a cardiac arrest and despite maximal efforts for cardiopulmonary resuscitation, she could not be revived. 3.?Discussion BPV has replaced surgery as the treatment mode for isolated pulmonary valve stenosis. It has been performed in all age groups with very good long term results. It is a safe procedure with a mortality rate of
