[HSF] Post -op care in tricuspid Valve surgery

[Nasser F. Abou'Seada]

Yes Prasanna, I quite agree. what is it you meant by keeping to third ?

NFA


On 5/3/07, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> That was why I kept it third. Some patients ifinadequately dried out can
> develop this and this typically occurs between day 3-7.
> Prasanna
>
> On 5/3/07, Nasser F. Abou'Seada <nfaabouseada at gmail.com> wrote:
> >
> > 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
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>
> --
> Prasanna Simha M
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC