[HSF] Endocarditis

[erdinç naseri]

Hal,
1.The presence of major CVA in a patient with proved lesion of a valve is an indication for surgery.
2.TEE of this patient didn't reveal any vegetation.(I consider it as  a good quality TEE, otherwise send the patient to a center with high qualşty TEE)
3.What if you find the mitral valve completely free of any infectious lesion?Proceed with MVR?Do nothing and terminate the op.?Inspect the aortic valve for infection?
It doesn't look as a good plan to proceed with operation in this particular patient.
erdinc> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Endocarditis> Date: Wed, 20 Jun 2007 18:11:17 -0400> From: hgrmd at aol.com> CC: > > > Erdinc,> >   The patient had a serious embolic stroke.  That is an indication for surgery.  If the valve is absolutely pristine, then I guess you could wait.  However, I would need to personally review the TEE before making such a recommendation.  In my experience, it is rare for the valve to suddenly become devoid of dangerous vegetations.  I have seen it on one case that I can recall in the past 21 years.> > Hal> > > -----Original Message-----> From: erdinç naseri <enaseri at hotmail.com.tr>> To: openheart-l at lists.hsforum.com> Sent: Wed, 20 Jun 2007 11:25 am> Subject: RE: [HSF] Endocarditis> > > > > > jit,> here are very strict guidlines for the surgical traetment of IE ( be it > lective or emergency) and in my opinion none of them exists in this patient.> .TEE is very informative in these patients and she doesn't have any vegetation > >10mm in left sided valves for surgical intervention).> .Causative organism is S. viridans which is very ab responsive.> .No CHF> rdinc> From: damle at cableone.net> To: OpenHeart-L at lists.hsforum.com> Date: Sat, 16 Jun > 007 23:07:44 -0500> CC: > Subject: [HSF] Endocarditis> > I would like some > dvice on the surgical indications in this patient:> > > > 45 yr female, > orticulturist, previously good health. Gradual insidious> onset of weight loss, > alaise last 3 months. Known to be positive for Hep C.> She was found to have a > ight adnexial mass and a right lung lesion and> initially thought to be cancer. > owever, the adnexial mass is proved to be> benign and the lung mass benign too > n PET scan. Echo 1 month ago showed> normal EF, severe narrow jet MR with > rolapsed posterior laflet, no> vegetations. Some one a did a blood culture two > eeks later, positive for> strep viridans. ID following, on antibiotics for 12 > ays, afebrile, normal> WBC, no fever, appetite better.> > > > Unfortunately had > left cerebral stroke 10 days ago. Sequential MRIs showed> most likely embolic > vent. Also small multiple other cerebral emboli of> various duration. These > ave small hemorrhagic foci. She was initially> aphasic, now improved a lot, > till can not walk. TEE a week ago and> yesterday show no change, no > egetations. Clinically, no CHF, CXR clear, no> hypoxia.> > > > Has had numerous > ultispeciality consultations. ID and cardiologists are> recommending MV > eplacement for "removing the focus of infection". The> indication being > ecurrent emboli. I am dithering because:> > > > 1. Too early after cerebral > nfarcts. Could make them much worse> > > > 2. No CHF, no decompensation> > > > > . Infection under control> > > > 4. At least on the TEE valve looks clean. She > ould be much better served by> a repair. Repairs have been done in MV > ndocarditis. If we are going to> repair and leave the valve in place, I do not > ee the urgency for doing it> now.> > > > My fear is, in spite of the benign TEE > ppearance, the valve leaflets are> actually infected and may be serving as a > ocus of recurrent thrombi.> > > > What do you think?> > > > Ajit Damle> > Fargo > D> > > > _______________________________________________> OpenHeart-L mailing > ist> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to > HANGE 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 > > isclaimers posted at:> http://www.hsforum.com/listdisclaim> > ----------------------------------------> ______________________________________________> penHeart-L mailing list> Send postings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/openheart-l> All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at:> ttp://www.hsforum.com/listdisclaim> ----------------------------------------> > > ________________________________________________________________________> AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.> _______________________________________________> 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> -----------------------------------------