[HSF] Tricuspid repair w/pulmonary hypertension

[hgrmd at aol.com]

Jim,
  Tough case.  The cardiologists generally give NTG during the right heart cath to see if the PA HTN is reversible.  I've done lots of cases like you describe.  Some of them don't do well.  I assume you have or will try milrinone, nitric oxide, prostaglandins, or Viagra.
Hal
 
 
-----Original Message-----
From: gammie at comcast.net
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 28 Feb 2007 11:18 PM
Subject: [HSF] Tricuspid repair w/pulmonary hypertension


HSF: 
elderly male 3vCAD, ef 50 %, severe mr (type I-dilated annulus), severe TR, PA pressures systolic 90. 
 
operation: 
CABGx4, 28 physio for mitral, 26 mc3 for tricuspid; 
 
postpump tee: no mr, no tr, good lv function. RV sick; unable to wean cpb despite usual measures: RVAD outcome uncertain. 
 
Qs: any reservations about correcting TR in face of near systemic pulm htn? 
  any role for assessing "reversibility" of pulmonary vascular resistance, like we do in transplant? 
  what is forum's experience with outcomes for mv/tv ops in patients with similar PA pressures? Literature suggests up front mort of 10-15 percent but fairly old experience... 
 
jsg  
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