[HSF] As with TR

[Nasser F. Abou'Seada]

"I would suspect he had Tr. Regurg. in the past. It might have  been absent
at the time of surgery (perhaps he had some "tuning  up" preop) and of
course it might not have been evident under anesthesia.  We know he had a
diseased liver (which is often undetectable with routine  testing). Then A
fib develops with a compromised right ventricle and its  annulus dilates and
the sick liver is subjected acutely to raised right  atrial pressures and
fails. One other possibility I have seen but in mitral  rather than  aortic
cases, is late paradoxical pulmonary hypertension,  which can have the same
effect on a vulnerable right ventricle. The key is  to make sure that any
history of previous Tric. Insuff. is picked up  even  even if the valve
seems fine at the time of surgery. A history of  previous Tric.  ins. is an
indication for tricuspid surgery
Bob"

Yes Bob ... I have seen quite "unexpected !!" similar cases with unfortunate
similar inevitable fate, in cases with history of hepatic Bilharziasis
!? ... apparently having had past troubles with the right side of the heart
"CHF" .... even though not apparent at time of later operation ...  the moto
became "always beware of a hidden compromised Liver / tricuspid / RV" ...
often associated, in rheumatic cases ! "socioeconomic variables !"

NFA


On 8/23/07, Rwmfglycar at aol.com <Rwmfglycar at aol.com> wrote:
>
>
> In a message dated 8/22/2007 10:30:28 A.M. Eastern Daylight Time,
> prasannasimha at gmail.com writes:
>
> Talking  of AS with TR we had a case operated by my colleague- severe
> calcific AS  in a HBSAg positive patient. Uneventful surgery and patient
> weanedwith 3  mics dopa dobut and adlib SNP. Of  ventilator etc over 6
> hours. On  post op Day 3 developed Afib and severe TR and went into
> fulminant  hepatic failure and died after 12 days.
> Prasanna
>
>
> Dear Prasanna,
> I would suspect he had Tr. Regurg. in the past. It might have  been absent
> at
> the time of surgery (perhaps he had some "tuning  up" preop) and of course
> it
> might not have been evident under anesthesia.  We know he had a diseased
> liver (which is often undetectable with routine  testing). Then A fib
> develops
> with a compromised right ventricle and its  annulus dilates and the sick
> liver is
> subjected acutely to raised right  atrial pressures and fails. One other
> possibility I have seen but in mitral  rather than  aortic cases, is late
> paradoxical pulmonary hypertension,  which can have the same effect on a
> vulnerable
> right ventricle. The key is  to make sure that any history of previous
> Tric.
> Insuff. is picked up  even  even if the valve seems fine at the time of
> surgery.
> A history of  previous Tric.  ins. is an indication for tricuspid surgery
> Bob
>
>
>
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