Comparison of Milrinone and Epinephrine on TAPSE

Cardiopulmonary bypass (CPB) is a critical technology in cardiac surgery, allowing for the temporary replacement of the heart and lung functions during intricate surgical procedures. it has significant post-surgical complications, the most important complications of CPB is right ventricle (RV) dysfunction. Diagnosis and management of RV dysfunction is crucial for maintenance of hemodynamic stability and organ function in early post-operation period and prognostic for later phase.

Inclusion Criteria: * American Society of Anesthesiologists (ASA) physical status II \& III * Age between 18 and 70 years * Both Gender * Body mass index less than 40 kg/m2 * Ejection fraction of \>40% * Tricuspid annular plane systolic excursion (TAPSE) \< 1.7cm Exclusion Criteria: * Patient refusal. * Preoperative RV impairment * Pulmonary hypertension (estimated pulmonary artery systolic pressure \> 50 mmHg) * Patients with any contraindications to Transesophageal echocardiography (TEE) * Redo or Re-exploration surgery * Patients with chronic kidney disease (serum creatinine \> 1.5 mg/ dl) * Patients with chronic liver disease (child pugh B and C)