Three steps to manage recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis
10.3760/cma.j.issn.1673-4904.2010.06.002
- VernacularTitle:三阶段法处理主动脉瓣狭窄患者瓣膜置换术中顽固性心室颤动
- Author:
Zaihao PAN
;
Jianrong GUO
- Publication Type:Journal Article
- Keywords:
Aortic valve;
Hypertrophy,left ventricular;
Arrhythmia;
Aortic valve replacement
- From:
Chinese Journal of Postgraduates of Medicine
2010;33(6):4-6
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study rational method for managing recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.Methods One hundred consecutive patients with valvular aortic stenosis who scheduled to receive aortic valve replacement were enrolled into the study.Three steps method was applied when ventricular fibrillation occurred after aortic unclamping.The first step was to correct disturbance of internal environment,intravenous lidocaine (100mg) and defibrillation (20-30 W/s); the second step was to inject norepinephrine to maintain mean arterial pressure 70-90 mm Hg (1mm Hg =0.133 kPa),then repeated defibrillation; the third step was infusion of magenisum sulphate (1g) and/or amiodarone (150 mg),then repeated defibrillation.Preoperative left ventricular mass index,mean arterial pressure,nasopharyneal temperature,serum potassium level and hematocrit after aortic unclamping were collected and compared.ResultsAfter aortic unelamping,56 patients recovered spontaneous rhythm without defibrillation,after the first step,16 patients could be defibrillated successfully,other 10 patients recovered spontaneous rhythm after the second step,still other 18 patients remained unresponse untill the third step.Patients who recovered spontaneous rhythm without defibrillation or needed the first step management had significant lower left ventricular ragas index when comparing with patients who entered the second step and third step management respectively [(184±43),(178±51)g/m~2 vs(237±61),(242±46) g/m~2,P＜0.05 ].Patients who needed the second step or third step management also had significant higher mean arterial pressure than the other patients.Conclusion Three steps method can be used to manage recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.
