caa a22 4500 445374470 CHVBK 20180317142958.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s00540-011-1104-9 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1104-9 Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis [Elektronische Daten] [Jahan Porhomayon, Mahmoud Hassan, Padmavathi Perala, Nader Nader] We report a case of an adult male who had received a gunshot to the abdomen 12years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF). Following endovascular repair of the ACF, we observed an immediate rise in systemic vascular resistance (SVR), decrease in central venous pressure (CVP), increase in regurgitant flow across the aortic valve, and decrease in central mixed venous oxygenation. A combination of vasodilators and vasopressors was used to maintain hemodynamics. Milrinone infusion was necessary after cardiopulmonary bypass to maintain cardiac output. Even though local anesthesia and light sedation were used for ACF closure, the hemodynamics changed dramatically throughout the procedure. ACF closure under local anesthesia and sedation is preferred because the hemodynamics alterations under local anesthesia are less severe. The rise in SVR and regurgitant flow across aortic valve is less dramatic. As a result, hemodynamic management and separation from cardiopulmonary bypass are easier. Japanese Society of Anesthesiologists, 2011 Aortocaval fistula nationallicence Hemodynamic nationallicence Endocarditis nationallicence Aortic valve nationallicence Porhomayon Jahan VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut Hassan Mahmoud VA Western New York Healthcare System, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut Perala Padmavathi VA Western New York Healthcare System, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut Nader Nader VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut Journal of Anesthesia Springer Japan 25/2(2011-04-01), 263-266 0913-8668 25:2<263 2011 25 540 https://doi.org/10.1007/s00540-011-1104-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1104-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Porhomayon Jahan VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Hassan Mahmoud VA Western New York Healthcare System, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Perala Padmavathi VA Western New York Healthcare System, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut NATIONALLICENCE 700 1- Nader Nader VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/2(2011-04-01), 263-266 0913-8668 25:2<263 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer