[HSF] Post -op care in tricuspid Valve surgery

[Nasser F. Abou'Seada]

Dear Dr. Zhou
interesting case. I wonder what was the pathology of the Tricuspid valve.
tethering of the leaflets,  is that likely to be a recent pathological
process ? 3 years before during first operation was the Valve OK ? and if so
what is the most likely pathology? apparently tethering was so severe that
inserting a ring was not successful. wide open TR, does that indicate a huge
annular dilatation? ?? ischaemic?? the history of recurrent CHF is very
suspicious ..?? ischaemic RVF on top of already tethered valve ?

I trust there were no way to fix the leaflets hence you had to replace the
valve. in my humble experience replacing the tricuspid valve has always
produced inferior results to trying to preserve the valve. the size of the
replaced valve denotes a huge RV, was the old valve preserved ? I mean
ventriculo-annular continuity? or was the whole tricuspid apparatus excised
?

Immediate improvement of the ascitis and liver condition does reflect the
effect of achieving comptency of the valve, I wonder whether later
deterioration would represent progressive RV dysfunction. any further RV
studies ? Any evidence of RV ischaemia ? renal functions ?

NFA



On 5/2/07, Zhandong Zhou <zzhoumd at pol.net> 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
>
> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC