[HSF] Tricuspid repair w/pulmonary hypertension

[Ben Bidstrup]

Pulmonary HTN is a risk factor or mortality after cardiac surgery. 
Additive Euroscore it has a weight of 2. However, you have to fix the 
TR as I like all of the others who have commented believe leaving it 
is worse.
I have had a few patients who have had persisting PHT after 
'successful' MV surgery. Not a  harbinger for a smooth sailing post 
op course.


o
>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon