[HSF] tricuspid regurg

[erdinç naseri]

Hal,
anesthesia guys were unable to put a swan preoperatively so I put one 
epidural cath in the pulmonary artery via RA and RV and one in LA 
transseptaly.One hour ago PAP was 50/35 and mean LA pressure 8 mmHg.Ra 
plication was to use the atrial wall as a felt( in some parts blood within 
th e RA  was visible).I viisted the patient one hour ago : agitated but 
responds to loud verbal commands.Total bilirubin/direct bilirubin 
^13/8(doubled in 12 hours)Already on lactulose.And the reason I used 
continous suture technique was to decrease X-clamp and CPB time.Exposure 
perfect and annulus very firm( continous with 3 pledgetted additional 
sutures at quarters)
erdinc


>From: hgrmd at aol.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 10:12:57 -0400
>
>Erdinc,
>   Sick tricuspid patient with severe preop hepatic dysfunction is having a 
>predictable postop course.  You should still have a Swan in place.  If so, 
>are the PA presssures still high?  If yes, consider adding milrinone.  
>Tough case, but it seems like you did everything appropriate surgically (I 
>wouldn't have used continuous suture for the MVR).  BTW, what benefit have 
>you seen from RA plication? Is there any literature to support it?  How do 
>you do it?
>Hal
>
>-----Original Message-----
>From: enaseri at hotmail.com.tr
>To: OpenHeart-L at lists.hsforum.com
>Sent: Sun, 15 Apr 2007 5:35 AM
>Subject: [HSF] tricuspid regurg
>
>
>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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