[HSF] acute aortic insuffiency dure to BE
Ani Anyanwu
anianyanwu at hotmail.com
Mon Feb 19 02:32:38 EST 2007
I think the valvar regurgitation is long standing. AI and MR and TR are all moderate and there is severe biventricular failure with dilated LV and pulmonary hypertension. Patient has had heart failure symptoms for several weeks. He is homeless and had not complained about this. He has a caecal mass which could either be cancerous or be the source of enteroccocus so felt best to work this up first. There are no absolute indications for surgery as of now (unless multiple vegetations or infective mass in RA are considered so) but however will need surgery for valvar disease.
Ani
----- Original Message -----
From: rwmfglycar at aol.com<mailto:rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
Sent: Monday, February 19, 2007 12:47 AM
Subject: Re: [HSF] acute aortic insuffiency dure to BE
Dear Ani,
If your patient is in failure waiting is very dangerous. As David says the deterioration can be starlingly fast. It can be rapid too in the apparently compensated patient with new wide open AI. The key is whether the endocarditis occurred on a previously competent normal valve with a ventricle of normal dimensions and wall thickness or on a diseased valve with chronic AI and a prepared ventricle.
Bob
-----Original Message-----
From: drdharris at yahoo.co.uk<mailto:drdharris at yahoo.co.uk>
To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
Sent: Sun, 18 Feb 2007 5:05 PM
Subject: Re: [HSF] acute aortic insuffiency dure to BE
I think one must be very careful about waiting too
long on a patient with acute aortic regurg due to SBE.
And if there is cardiac failure (which is acute), the
patient can decompensate in hours. I have seen the
cardiac shadow on CXR enlarge dramatically overnight
in these patients. I do not think these cases can be
compared with a left main (which can usually be
stabilised medically and with IABP - with our long
waiting lists I`ve seen left mains wait months for
surgery). This case is analogous to an aortic
dissection, and should wait no longer than the next
day, during which time aggressive treatment of CCF in
ICU should be started (inotropes).
--- Ani Anyanwu <anianyanwu at hotmail.com<mailto:anianyanwu at hotmail.com>> wrote:
> 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<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 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<mailto:anianyanwu at hotmail.com%3Cmailto:anianyanwu at hotmail.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: 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<mailto:Hgrmd at aol.com%3Cmailto:Hgrmd at aol.com%3Cmailto: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<mailto:OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart-L at lists.hsforumcom>>>
>
> 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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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon
Suite A2
Tygerberg Hospital, 7505
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Tel +27-21-9762347
Fax +27-21-9761157 Mobile +27-83-3309587
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