[HSF] acute aortic insuffiency dure to BE

[Ani Anyanwu]

Oh Hal I do not know/have a right answer! I was just asking you a question on your current thinking on timing of surgery for endocarditis... Actually have a not too dissimilar patient I saw last week with aortic and mitral, RA endocarditis, vancomycin resistant enterococcus, from dialysis catheter (ESRD) with loads of other medical issues and I am in no hurry to rush to the OR (might do sometime next week).

Ani
  ----- Original Message ----- 
  From: hgrmd at aol.com<mailto:hgrmd at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Friday, February 16, 2007 4:04 PM
  Subject: Re: [HSF] acute aortic insuffiency dure to BE


  Ani,
    The patient was cathed today.  He also needs grafts to the CX and RCA.  Therefore, the patient needs 3 valves and 2 grafts.  You're right, I should probably do it over the weekend.  However, with a bunch of patients and hospitals to cover, I plan to wait until Monday morning.  Don't tell me you haven't left a few severe, but stable left mains over the weekend.
  Hal 
   
  -----Original Message-----
  From: anianyanwu at hotmail.com<mailto:anianyanwu at hotmail.com>
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  Sent: Fri, 16 Feb 2007 3:27 PM
  Subject: Re: AW: [HSF] acute aortic insuffiency dure to BE


  Hal

  Why Monday (which is 72 hours time - why not earlier or why not later)?

  Ani
    ----- Original Message ----- 
    From: Hgrmd at aol.com<mailto:Hgrmd at aol.com<mailto:Hgrmd at aol.com%3Cmailto:Hgrmd at aol.com>> 
    To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart-L at lists.hsforum.com>> 
    Sent: Friday, February 16, 2007 7:34 AM
    Subject: Re: AW: [HSF] acute aortic insuffiency dure to BE


    Roberto,
      I basically agree with you.  However, I don't believe the  patient was in 
    CHF.  The vegetation was 5 mm with no evidence of  emboli.  He was afebrile 
    with a mildly elevated WBC.  No positive  blood cultures.  All in all, I think 

    the patient will need surgery.  I  just don't think it is really urgent.
      In contrast, I was just referred a case of an 80 yo man with fever,  strep 
    bacteremia, and a small TIA.  Echo reveals a 1.7 cm vegetation on the  aortic 
    valve.  There is 4+ AI, 2+ MR, and 3+ TR with good LV  function.  He gets a 
    cath today.  He gets surgery Monday.
    Hal
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