[HSF] SBE and the Indications for Surgery

[erdinç naseri]

large vegetation is an indication for emergent surgery.
erdinc naseri


>From: Hgrmd at aol.com
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: [HSF] SBE and the Indications for Surgery
>Date: Sun, 4 Feb 2007 17:38:00 EST
>
>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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