[金山毒霸识别此邮件为垃圾邮件]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery

[prasannasimha]

The hemolytic anemia has to be confirmed by a smear and biochemical 
tests. If confirmed the mechanism is usually due to a small jet hitting 
a Dacron ring. This has been well described in literature and this is 
why I prefer Goretex or pericardium for rings (These are not associated 
with hemolysis in the case of a jet hitting the ring). I had seen this 
first in a young girl during my training days and was actually a case of 
primum ASD with a Dacron patch and a ? Cooley collar.
Management is to add a beta blocker and Trental (Pentoxyfylline) under 
the hope that the jets destructive force comes down. This  may allow 
endothelialization/ cover of the ring with pannus which will eliminate 
the MR (I had one case with a Cooley Collar again with this problem and 
it resolved with this - had a very minor MR jet). If this does not 
settle with 3 months treatment then you will have to go in and rerepair 
with a perfect result or replace the valve according to your comfort 
level. If rerepairing cover the ring with Pericardium.
Prasanna
陈鑫 wrote:
> Dear Members, I would like to have your thoughts about the following case.
>
> 57 male had severe MR ( 4+) from mitral posterior leaflet prolapes, And received mitral repair ( Q resection of the posteroir leaflet and 29# ring  ( O shape ), TEE showed 1 one +  MR during surgery. He had uneventful recovery and went home. Three weeks after surgery, he had jaundice and hemolysis with elevated hepatic enzyme. HCT went down from 40 to 30%. Even after 6 weeks medical treatment, his jaundice getting better and hepatic enzyme went down too, but not normal yet. We checked echo again it shows that the size of LA and LV is smaller that that before surgery, and have + to ++ MR, with a II/6 systolic murmer. EF is normal. Now he is about 3 months after. 
>
> Is his jaundice and hemolysis related to the ring or repair? Should we do anything surgically? Replacememt of the mitral valve? or wait? or other? 
>
> Many thanks in advance for your help. 
>
> Steve 
> ------------------------------------------------------------------------
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies and 
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> ------------------------------------------------------------------------
>
> No virus found in this incoming message.
> Checked by AVG Free Edition. 
> Version: 7.5.476 / Virus Database: 269.10.4/897 - Release Date: 7/11/2007 9:57 PM
>