Hemodynamics Case 9

Patient with a history of coronary artery disease and severely impaired LV function with PA pressure of 45/20 mmHg to undergo coronary artery bypass grafting with left internal mammary artery. Patient’s bypass course is complicated by hypotension requiring norepinephrine (phenylephrine and vasopressin were not effective). This is a high risk coronary artery bypass grafting with a low ejection fraction, that is complicated by vasoplegia on bypass. The TEE clip below is obtained post-bypass.

The most likely drug(s) that will be needed to come off of cardiopulmonary bypass are:

1. Nitric oxide
2. Dobutamine
3. Milrinone/NE/Methylene blue
4. Dopamine
5. None of the above