Partial inferior vena cava snaring to control ischemic left ventricular dysfunction

Abstract

Purpose: To describe the hemodynamic and intraoperative transesophageal echocardiographic evaluation of cardiac systolic and diastolic function in a patient undergoing off-pump coronary artery bypass graft (OP-CABG) surgery who developed pulmonary artery hypertension controlled by inferior vena cava (IVC) snaring. Clinical features: A 63-yr-old man was referred to our hospital for elective OP-CABG surgery. His preoperative ventriculopathy revealed a decreased systolic function (ejection fraction of 35%), and a mild mitral regurgitation. Intraoperatively, after application of the stabilizer and clamping of the diagonal artery, he developed a marked increase in pulmonary artery pressure (PAP) with a decrease in systemic arterial pressure, non responsive to iv norepinephrine and nitroglycerin. Transesophageal echocardiographic evaluation revealed a marked decrease in systolic function and presence of a restrictive diastolic filling pattern. Partial IVC snaring decreased the venous return and PAP decreased cardiac chamber dimensions, improved systolic function and improved diastolic filling pattern. Conclusion: Partial IVC snaring was used successfully to treat a hemodynamically unstable patient with sudden increase in PAP caused by ischemic left ventricular failure during OP-CABG.