[HSF] MVR in dilated LV

[Nasser F. Abou'Seada]

Surely an anti-AF technique is part of the procedure ... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Monday, October 16, 2006 9:48 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] MVR in dilated LV
> 
> 
> Patient with Afib and EF 40 % can very well be due to tachycardia
myopathy.
> I would replace his valve and emaze him after a complete course of
> antibiotics and a demonstrable afebrile period.
> Prasanna]
> nand kejriwal wrote:
> > Dear members
> >
> > I have been referred a 45 year old gentleman for opininon regarding Redo
> > Redo MVR. He underwent mitral valve replacement in 1971 when apparently
a
> > stented homograft was used. The valve degenerated and in 1990 it was
> > replaced with a 31 mm Intact bioprosthesis, as he was reluctant to take
> > warfarin. Recently he presented with endocarditis and grew
> > Streptococcus. He
> > has completed the full course of antibiotics and is now afebrile with
> > normalisation of the lab parameters. A recent TOE revealed a small
healed
> > vegetation with severe MR. The problem is that his LV is markedly
dilated
> > with impaired systolic function. The ESD is 5.96cm and EDD 7.49 cm. EF
> > 40%
> > FS 20.4%. Gradient across prosthesis 19mm, mean 8.8. RV syst pr are
47.6.
> > Initially, the feeling was that the LV had dilated acutely due to acute
> > degeneration of the prosthesis because of endocarditis. But on
> > scanning his
> > previous echo reports, it appears that his LV was quite dilated even
when
> > the prosthesis was intact. The ESD was 5.2 in 2004 (EDD 6.82) and
> > 6.1(EDD7.3)
> > last year. There was no MR then. . He is now in AF and is on warfarin
> > now.
> > He has NYHA class II symptoms, but otherwise does not have significant
> > co-morbidies. Should this patient be accepted for MVR or should I
> > refer him
> > to the transplant team?.
> >
> > Thanks for your opinion.
> >
> > Nand
> >
> > Nand K Kejriwal
> > Consultant Cardiothoracic Surgeon
> > Waikato Hospital
> > Hamilton, New Zealand
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