Correct !
4. 1 and 3

The patient is doing clinically well. He does have some weight gain post-operatively but this is not unusual after a major operation and aggressive diuresis is not indicated. He does have cardiomegaly but this is probably due to his valvular insufficiency since it has not changed compared to his admission radiograph. Performance of a baseline bedside echocardiogram is common post-operatively and will help to identify any impending or potential complications.

A 4-chamber view from the beside echocardiogram is shown in Figure 2.

Figure 2. Bedside echocardiogram in the ICU.

The echocardiogram was interpreted as showing:

• Status post 27/29 mm mechanical bileaflet aortic valve prosthesis; Normal prosthesis. Systolic mean Doppler gradient; 14 mmHg. Trivial prosthetic regurgitation (closing volume).
• Normal left ventricular chamber size. Calculated ejection fraction; 60 %.
• Abnormal ventricular septal motion with respirophasic shift. No other findings for constriction or regional wall motion abnormalities.
• Moderate decrease in right ventricular systolic function.
• Estimated right ventricular systolic pressure; 23 mmHg.
• Mild ascending aorta dilatation (diameter 41 mm at mid level).
• Tiny, insignificant apical pericardial effusion.

On the fifth post-operative day he was sitting in the chair and pleasantly conversant. His urine output the previous day was around 2 L; however, since midnight, it has decreased dramatically. His creatinine yesterday was normal but has increased to 2.6 mg/dL with an accompanying increase in BUN. His WBC has increased to 10.8 X 109 cells/L and his K+ to 5.5 mEq/L with a mild metabolic acidosis.

Which of the following should be performed at this time? (Click on the correct answer to proceed to the third of five panels)

1. Bladder scan
2. Ensure the patency of the bladder catheter
3. Renal ultrasound
4. Urinanalysis and culture
5. All of the above

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