[HSF] Post -op care in tricuspid Valve surgery

[prasannasimha]

Things that I would consider
1)Flash Pulmonary edema (if obvious MR is not seen at other times) - If 
this is suspected slow introduction of beta blockers.
2)New onset MI (If there is RWMA)- then it would be management of pump 
failure.
3) Return of fluid to the intravascular compartment due to fluid shifts 
after correction of TR.- I would weigh the patient - this sort of 
patient with ascites etc perop needs to be at lest 10 Kg less than preop 
weight. Pitting pedal/presacral edema (even if mild) still means 5- 8 
Kgs of fluid overload .I would then consider  a loop diuretic infusion  
with added Spironolactone.
All this requires on Echo or TEE assessment.
Incidentally what do you attribute the TR due to - this would be unusual 
post CABG .
Prasanna

Zhandong Zhou wrote:
> 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
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