[HSF] Traumatic tricuspid regurg

[prof.dr.axel laczkovics]

massive TI immediately after removal  of a RV lead is clearly due to 
rupture of chordae and/or part of the valve.  therefore also repair 
will not be possible and a course of AB makes no sense to me.

i would be interested in symptoms: has the pt aszites? liver 
enlargment? is the symptomatology dependent from the position  of the 
pt (supine vs upright?). can the hemodynamic  situation change by time, 
after the RV has adapted to the situation?

in my experience many years ago (treating several 1000 pm-pts in my 
viennese times) we observed TI after removal ( or call it exhairesis) 
of the lead, but always handled them conservative. but maybe overlooked 
some  forms of massive TI.

what would cardiologists think?

axel laczkovics


Am Donnerstag, 04.01.07 um 12:37 Uhr schrieb 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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