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HM II Candidate Profiles and Pre-Operative Assessment Check List

Age: 68 Years Gender: Male LVEF: 16% on ECMO


Height: 180Cm Weight: 70Kg BSA(m2): 1.87

Heart Failure Etiology:


Acute Myocardial Infarction Congenital Heart Disease Dilated Myopathy Ischemic
Restrictive Myopathy Arrhythmia Coronary Artery Disease
Hypertrophic Valvular Heart Disease Cancer
Cardiomyopathy
Dilated Myopathy Post Cardiotomy Cardiogenic Other Please describe:
Idiopathic Shock _________________________

Indication:
Bridge to Transplant Destination Therapy Post Cardiotomy
Myocardial Recovery Other Please describe: _________________________

Risk Factors Weighted Scores: Score


Platelet count <148 x 10/l Score : 7 (58,000) 07
Serum albumin <3.3g/dl Score: 5 (2.4) 05
International normalization ratio > 1.1 Score: 4 (1.5) 04
Vasodilator therapy Score : 4 (No) 00
Mean pulmonary artery pressure <25 mmHg Score: 3 (05) 03
Aspartate aminotransferase > 45 U/mL Score: 2 (38) 00
Hematocrit <34% - Score : 2 (28) 02
Blood urea nitrogen > 51 mg/dl Score: 2 (35) 00
No intravenous inotropes Score: 2 Yes 00
Total Score: 21
0-8: Low risk 9-16: Medium risk 17-19: High risk >19: Very high risk

Right-Heart Function: Desirable Value Current Value


RVSWI >300 mmHg x mL/m 303mmHg x mL/m
Central venous pressure <15 mmHg 06 mmHg
Tricuspid regurgitation Minimal to moderate Minimal
Pulmonary vascular resistance < 4 woods units 4.6 woods units
Transpulmonary gradient <15 mmHg 1.96 mmHg
RV Size 2.9 cm
RVEDV <200 ml 33ml
RVESV <177 ml 11ml
Need for pre-op ventilator support None Yes
RVSP: 22+5=27 mmHg
TAPSE: 2.4cm
RVEF : 53% on ECMO
LV d (diastole): 6.3CM
LV d (systole): 5.2CM
RWMA: Globally reduced, Apex aneurysmal , Secondary Echo Contrast present but No LV clot
Aortic root (size) : 3.2cm
AR : Trivial
MR: Trivial
IVS: 0.9CM
IAS: 0.8CM
HR : 46/min on metoprolol infusion 0.75mg /hr
HR rhythm : NSR

Other Remarks:
Pacemaker/CRT-P/CRT-D/AICD Implant: Prosthetic Heart Valve Implant:
VVIR MRI ICD
Date of Implant: 05/12/2009 Date of Implant:

Model of Device: DVMB2D1 Model/Type of Valve:

Metabolic Markers: Desirable Value Current Value


Renal
Blood Urea Nitrogen <40 mg/dl 35mg/dl
Serum Creatinine <2.5 mg/dl 1.12mg/dl
Estimated GFR >50 ml/kg/min 56.63
Serum Potassium 3.9
Serum Sodium 138
Serum Bicarbonate 20.8
Serum Lactate 1.2
Metabolic Markers: Desirable Value Current Value
Hematology
INR <1.2 1.5
Hemoglobin >10 g/dl 8.1
Platelets >150,000/mm 58,000

Nutritional
Pre-albumin >15 mg/dl
Albumin >3 g/dl 2.4
Transferrin >250 mg/dl

Hepatic
Total bilirubin <2.5 mg/dl 2.85
ALT, AST <2 times normal YES

Hemodynamic
Right atrial pressure <15 mmHg
PCWP <24 mmHg
ABP 120/70mmHg
Current Condition: On venitlator since 21/09/2017 & On ECMO Since 22/09/2017
Admitted/Non admitted: Yes
If yes since when: 16/09/2017
On ventilator: Yes
If yes Since when: since 21/09/2017
Inotropic support: Yes
Pl specify: Drugs & Dosages: Noraderiline 0.02mcg/kg/min
On IABP: NO
If yes Since when: N/A
NYHA Class: Class II
Suffering from Intractable ventricular arrhythmia since 1week
Current LVEF %: 16% On ECMO
X- ray: Cardiomegaly , grade 1 pulmonary venous hypertension
Pulmonary Function: on FiO2 of 60% PO2 = 92 and PCO2 = 35
PFT: can not be done as patient is on ventilator
Coronary Angiogram: LAD- TIMI 1 Flow with ISR OF 70-80%, LCX- Codominant circulation with minor
plaque present, RCA-
Hb: 8.1
TC: 8,100
ESR:
Temp: 34.5C
Infection if any: No evidence
Recent history of illness: VT storm since 1 week, on ventilator, on ECMO
Past history of any surgery: PTCA, ICD (2009), CARTO (2011)
Any other disease: Non diabetic, Non hypertensive, k/c/o CAD

Current medications: Inj. Cefoperazone + sulbactam 1.5gm iv tid


Inj. Clindamycin 600mg iv tid
Inj. Metoprolol 0.75mg/hr infusion
Any specific concerns: