[HSF] Tricuspid repair w/pulmonary hypertension

[prasannasimha]

Speaking of that - remember the patient who underwent emergent MVR for a 
ruptured mitral valve  post balloon mitral valvotomy and who had a 
difficult wean off CPB due to high PA pressures and normal valve 
function (and required to be Lazarussed off CPB).His PA pressures came 
down with Sildenafil but he is erratic in treatment and stops it. (At 
the end was found to have COPD) Well he was in  the medical ICU 
yesterday (his PA pressure up - has stopped Sildenafil and also the 
alternative nitrates which we had prescribed since he was stopping 
Sildenafil on hi own and I suspect to be due to costs) severe PH TR. RV 
Failure. Seems that that will be a cycle of admissions/discharges till 
death.
Prasanna
Hgrmd at aol.com wrote:
> 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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