[HSF] tricuspid regurg

[erdinç naseri]

Prasanna,
ALT and AST around 110 and declining compared to yesterday.Preop PT 15.9 
postop 16.5,preop creatinin 1.1 postop 1.8.No amoniac test available ( quite 
familair with the smell but absent in this patient)
erdinc


>From: prasannasimha <prasannasimha at gmail.com>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: Re: [HSF] tricuspid regurg
>Date: Sun, 15 Apr 2007 15:17:46 +0530
>
>How  is her hepatic function  especially enzymes , PT and ammonia if 
>available? Many patients with real bad livers due to TR get up slowly if 
>they metabolize drugs slowly and it is necessary in these patients to use a 
>lower dose.
>Is the patient lacrimating ?
>Prasanna
>erdinç naseri wrote:
>>
>>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
>>
>>
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