[HSF] tricuspid regurg

[erdinç naseri]

To all members,
49 y/o cachectic lady with severe ascites and jaundice,unable to walk( NYHA 
class IV)
Echo:Aortic regurg(+),mitral regurg(+++),Mitral stenosis( mean gradient 15 
mmHg),tricuspid regurg(++++),PAP 70mmHg,RAand RV very large,
CXR:C/T 0.95 ,EKG:AF,hiperbilirubinemia and elevated  hepatic fx results.
Operated the day before yesterday:severe rock like pericardial adhesions 
.femoral arterial cannulation ,left the heart untouched except for aorta and 
RA,RA very thin walled and diameter around 25 cm,Giraudon incision,mitral 
valve severely calcific with extension to the subvalvular apparatus,MVR with 
continous technique,aortotomy revealed good leaflets so left it 
untouched,Tricuspid ring annuloplasty with a cut St.Jude ring leaving septal 
leaflet untouched(ring that large  was unavailable) on beating heart.Checked 
the patency with saline infusion(TEE probe out of use): TR +,RA 
plication.Operation terminated with  mild inotropic support(systemic BP 
110/60 PAP 70/45).Postoperatively hepatic functions improving but creatinin 
1.8.Postop 2.nd day and she is still sleepy and only opens eyes on loud 
verbal command ,muscular tonus and ventilation insufficient.Can not take her 
to CT( a must before real neurologic consultation in this part of the 
world).Any opinion
erdinc