[HSF] 21 Year old S/P TOF repair with Moderate to Severe AI, 1 cm residual VSD and 30 mmHg RVOTO

[tdmartin2000 at aol.com]

Male or female?


-----Original Message-----
From: ichfno at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 15 Nov 2007 4:05 am
Subject: [HSF] 21 Year old S/P TOF repair with Moderate to Severe AI, 1 cm residual VSD and 30 mmHg RVOTO



Polling the group, what would you do with 21 year old, 12 years post-op TOF 
repair, valve sparing, now with 10 mm residual VSD, under aorta, moderate to 
severe AI and 30 mm Hg RVOT obstruction? 

WNovick


-----Original Message-----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 15 Nov 2007 1:58 pm
Subject: Re: [HSF] I used aprotinin today



Thanks for the follow up.
What is procrit and why cannot just plain oral Fe and good nutrition do -
along with a wholesome diet and probably some protein supplementation like
ensure do ?.
A Hb of  above 8.00 Gm/dL with normal oxygen extraction and lactates is
sufficient. We should just treat physiology and not some whimsical number.
In fact raising the Hb may in fact make blood more viscous and clot grafts.
If she is doing well it may be wise to leave her alone to mend her self  now
!!
Prasanna

On Nov 15, 2007 8:57 AM, <Cysmd613 at aol.com> wrote:

> I operated on my Jehovah's Witness patient today.  Her pre op Hgb this
> morning was 12.2 and HCT 37.4.  I "chickened out" and used amicar instead
>  of
> aprotinin, given that she is an 80 yo woman and with all the media
>  attention.  Her
> renal function is normal.  I did CABG x 5 including  LIMA and 4 SVGs.  The
> anesthesiologist took off about 350cc of blood  pre bypass.  Her HCT prior
> to
> coming off bypass was 22.  Her  HCT before giving back her own blood plus
> about
> 300cc of cell saver was  24.  It took more than 30 minutes before the
> first
> drop of blood  came out of the mediastinal chest tube.  In the 9 hours
> since
> surgery, she  has put out a total of only 140cc.  I only got 1 blood gas
> post op
> (only because the O2 sat monitor wasn't picking up) which had her HCT at
> 30.4.  She is doing very well.  She is not extubated yet because she  is
> still
> sleepy, but hopefully soon.
> Now, post op, since her Hgb is less than 12, the hematologist is willing
> to
> give more procrit and IV iron.
>
> Thank you to all who gave advice.
>
> Carmi
>
>
>
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-- 
Prasanna Simha M
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