[HSF] SBE and the Indications for Surgery

[Tea Acuff]

What was the bug
tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, February 4, 2007 4:38:00 PM
Subject: [HSF] SBE and the Indications for Surgery


Dear Members,
  About 3 months ago, I was asked to see an 80 yo fairly frail lady  with 
mitral staph SBE.  By the time I saw her, she was afebrile with mild  
leukocytosis.  The coronaries were normal by cath and the EF was 50%.   TEE revealed a 15 
mm vegetation on the posterior leaflet with moderate MR.   There were no 
overt signs of CHF.   A t the time I suggested surgery  based on the large 
vegetation.  I was all set to operate, when, on the day  before, the ID doc stepped 
in and emphatically stated that surgery was not  indicated.  He felt that 
sepsis appeared to be controlled with anitibiotics  alone and that there were no 
indications for surgery.  He also told that to  the patient and her son.  I 
backed off and let them have their way.  
  Last Friday, I was reconsulted on this patient.  She had  represented with 
a large right hemispheric CVA.  She was now blind in the  left eye and unable 
to move the left side.  She's screwed.   Transthoracic echo now revealed 
severe MR with poor visualization of the  posterior leaflet. The family told me 
they wished they had listened to me.   The point is that large vegetations alone 
are current indications for surgical  intervention.  Anybody disagree?
Hal
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