![]() Thus, CPB was switched to venoarterial ECMO. Her cardiorespiratory status heavily depended on CPB. Pulmonary edema then developed, and oxygenation worsened, and these developments were deemed to constitute primary graft dysfunction (PGD). These findings suggested LV diastolic failure. Transesophageal echocardiography (TEE) showed dilated left atrium and hyperdynamic RV and LV (Table 1). At the weaning from CPB (under 40 % of CPB support), her heart rate, PAP, and pulmonary wedge pressure elevated to 140 beats/min, 40/14/23 mmHg, and 20 mmHg, respectively, whereas central venous pressure remained 12 mmHg and arterial pressure remained 67/54/59 mmHg. After reperfusion, noradrenaline (0.25 μg/kg/min), dobutamine (2.5 μg/kg/min), and milrinone (0.25 μg/kg/min) were started. Before reperfusion of the graft, nitric oxide (NO) inhalation was initiated and methylprednisolone (1000 mg) was administered. Both lungs were then excised, and the bilateral lung graft was implanted. During cardiopulmonary bypass (CPB), ASD patch closure and PA replacement with homograft were performed. Circulation was supported by noradrenaline (0.15 μg/kg/min), phenylephrine (0.25 μg/kg/min), dobutamine (1 μg/kg/min), milrinone (0.25 μg/kg/min), and nicorandil (1 μg/kg/min). Anesthesia was induced with midazolam (1 mg), fentanyl (300 μg), and rocuronium (40 mg), and maintained with propofol (1.8 mg/kg/h), remifentanil (0.3 μg/kg/min), fentanyl (total, 1.5 mg), and rocuronium (10 μg/kg/min). Assessment of perioperative cardiac function is very important in BLTx combined with cardiac surgery.īefore the induction of general anesthesia, venoarterial extracorporeal membrane oxygenation (ECMO) was initiated. Especially, perioperative management of the BLTx patient with LV diastolic dysfunction was difficult. These patients needed different management because of their different LV function. He underwent ASD and VSD patch closure, pulmonary artery replacement, and BLTx under CPB. General anesthesia was induced smoothly without ECMO. ![]() Patient 2 was a male with Eisenmenger syndrome, which resulted from ASD and ventricular septal defect (VSD). We gradually decreased the ECMO support and eventually weaned off the ECMO on the 4th postoperative day (POD) and the ventilator on the 29th POD. ![]() At the weaning from CPB, primary graft dysfunction and pulmonary edema induced by LV diastolic dysfunction was apparent. She underwent ASD patch closure, pulmonary artery replacement, and BLTx under cardiopulmonary bypass (CPB). We initiated venoarterial extracorporeal membrane oxygenation (ECMO) before induction of general anesthesia. She had a very small left ventricle (LV). Patient 1 was a female whose pulmonary hypertension resulted from a congenital atrial septal defect (ASD) and idiopathic pulmonary arterial hypertension. According to him, 2 the orthopneic position provides relief because it secures the following mechanical advantages: 1.We report on two patients who underwent bilateral lung transplantation (BLTx) combined with cardiac surgery. Hofbauer, 1 however, showed that the chief respiratory difficulty in orthopneic patients was expiratory rather than inspiratory, and that the accessory muscles of expiration did not function more efficiently in the upright posture. REVIEW OF THE LITERATURE The earlier writers generally believed that the sitting posture was assumed because the accessory muscles of inspiration could then be used to greater advantage. Numerous theories of the pathogenesis of orthopnea have been advanced, but none completely accounts for all the characteristics of the phenomenon. The factors that impel patients with myocardial failure of the congestive type to sit up in bed in order to breathe more comfortably have aroused the curiosity of many investigators.
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