[HSF] Post -op care in tricuspid Valve surgery

[Zhandong Zhou]

To Forum:

I recently operated on one of my patients whom I performed CABG 3 years ago, 
now she has severe tricuspid valve insufficiency. Repeat cath show grafts 
with LIMA to LAD, Radial artery to OM and SVG to PDA. Echo show wide open TR 
and TEE show enlarged RV with PA pressure 36 systolic. Tricuspid valve 
regurgitation mostly due to tethering of leaflets. She required multiple 
admission for right side failure, ascites, enlarged liver and spleen. Cath 
show CVP 27.

I put a ring there first withnot success, then I decided to replace the 
valve (31mm pericardial). Surgery went very well with mini thoracotomy. Her 
edema is much better and liver shrinked. However, she developed multiple 
episodes of pulmonary edema which is very difficult to manage. She looked 
very good on the day of dischage, but came back next day requiring 
reintubation.

I want to know what is your experience in managing this kind people. Thanks!

Z Zhou