[HSF] Post -op care in tricuspid Valve surgery

[Nasser F. Abou'Seada]

Prasanna
while I would agree, management wise with your suggested management, I would
be reluctant to consider fluid shift post correction of TR, that would be a
function of the many other variables. still I would totally agree with your
plan of symptomatic management.

Dr. Zhou: any results of Total plasma proteins and albumin ?

NFA


On 5/2/07, prasannasimha <prasannasimha at gmail.com> wrote:
>
> 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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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC