[HSF] Traumatic tricuspid regurg

[erdinç naseri]

Though no microorganism is grown in the cultures still there is a 
possibility of culture negative lead infection.Human heart can tolerate lack 
of the tricuspid valve for a good while( e.g tricusğpid ecision in drug 
addicts), so an antibiotic trial against infective endocarditis followed by 
elective tricuspid repair,whatever suits best intraoperatively ,will be the 
best option.
erdinc naseri


>From: "nand kejriwal" <nkkejriwal at gmail.com>
>Reply-To: OpenHeart-L at lists.hsforum.com
>To: OpenHeart-L at lists.hsforum.com
>Subject: [HSF] Traumatic tricuspid regurg
>Date: Thu, 4 Jan 2007 22:02:31 +1300
>
>Dear members
>
>An interesting case has been referred to me. The patient is a 65 year old
>lady who underwent dual chamber pacing a few years ago. Recently she
>presented to the cardiologist with pacemaker pocket site infection. The
>cultures did not grow any bug, but the generateor was eroding through the
>skin. Last week the cardiologist pulled out all the hardwares. Apparently 
>he
>tore one of the pap m of the TV while removing the RV lead. Now the patient
>has severe TR. I am enclosing the echo frames showing the bit of pap m with
>attached chordae flopping in & out of RV resulting in severe TR. The 
>patient
>had mild to mod TR before the lead removal. There is no evidence of TV
>endocarditis on echo. The annulus measures 40mm. Normal coronaries.
>
>What is the best option?
>Repair by suturing the muscle back and putting an annuloplasty ring? Will 
>it
>work? My concern is that if the lead were infected, would it be wise to
>leave the leaflets behind?
>
>Or, remove all the leaflets with chordae and insert a bioprosthesis?
>
>I am also planning to attach RV & LV epicardial leads. I shall sew the LV
>lead close to the 1st OM artery posteriorly. What is the best spot for the
>RV lead?
>
>Thanks
>
>Nand


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