[HSF] Tricuspid repair w/pulmonary hypertension

[Hgrmd at aol.com]

Erdinc,
  I'm not sure what the upper limit of PA HTN that should  categorically 
disqualify a patient from surgery.  If the lesion is CAD  alone, then I find the 
patient usually has intrinsic lung disease producing most  of the hypertension. 
 However, if one or more valves is involved, then the  hypertension can 
usually be reversed with surgery. One of the keys is whether  any reversibility is 
demonstrated at cath.  If the PVR is fixed, then the  pulmonary vascular beds 
are fibrosed and the patient will not be helped with  surgery.  This is very 
common in congenital cases, but fairly uncommon in  the adults that I've seen.  
I, and I doubt you, carefully follow these  patients for months and years to 
see how they fare.  A surgeon in private  practice doesn't have the time or 
resources available to do as such. However, I  know I've seen several that were 
at least a couple of years out and doing  well.
 
Hal
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