[HSF] Pegnancy and LA Clot

[erdinç naseri]

Dear Dr.Martin,
Why should I leave an aortic root of 4.8 cm untouched and do seperated AVR 
and Ascending aortic replacement. Dear prasanna though there was no report 
of the FS in echo report the cardiologist looked in the echo device and 
reported it as18.Waiting for your comment.
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] Pegnancy and LA Clot
>Date: Sat, 28 Apr 2007 07:21:35 +0530
>
>This is unfortunately a "common" situation.
>Normothermic bypass High flow(2.8 - 3 L/m2/min), fetal monitoring. 
>Magnesium and NTG. No SNP . Minimize Inotropes.Shorten CPB. Probably 
>placing a catheter near the uterine artery with NTG/ritodrine seems to be a 
>tantalizing option to me now (Not done it but would consider it now in the 
>light of TRT)
>OMV + TV plasty + emaze.If forced to do an MVR consider a bioprosthesis or 
>else mechanical valve and discussion with family about importance of PT 
>monitoring.
>Incidentaly does she want more children ? (ie has she already had children 
>?)
>Pray that the fetus survives. (Tell that to the patient and her relatives) 
>.
>Avoid teratogens.
>She needs to be live to be pregnant and she cannot do that with a fatal 
>stroke.
>Prasanna
>
>sekhar le wrote:
>>We have a 40 yrs female admitted for elective mitral valve replacement for 
>>severe MS[MVOA-1cm],severe TR, PA pressure 75..She is in sinus rhythym and 
>>had CVA 5 months back.TEE showed a big  LA clot.
>>Incidentally it was realised she is 3 months pregnant  by ultra sound[had 
>>h/o irregular periods for 2 yrs which probably lead to late recognition of 
>>pregnancy].
>>How should we proceed? Ignore pregnancy and opt for urgent MVR?
>>
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