[HSF] Would anyone operate (am I a glutton for punishment?)

[Tea Acuff]

Surgery like death may be inevitable, but why rush into either!

tea


----- Original Message ----
From: "tdmartin2000 at aol.com" <tdmartin2000 at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, November 26, 2007 7:51:33 PM
Subject: Re: [HSF] Would anyone operate (am I a glutton for punishment?)

He obviously needs an operation at some point in time. The question is when? There is nothing wrong with very aggressive medical management, including admission with inotropic support if need be, like a pretransplant pt, until he improves somewhat. Surgery in this situation is not emergent and given his hematologic abnormalities I would seriously consider waiting. I currently have a pt in house that has been in the hospital for almost 3 months (most of that at an outside hospital) being treated for endocarditis, CHF, antilupus antibody syndrome, HIT and renal insufficiency. He is now culture neg, on argatroban, HIT neg and on dialysis,? but walking in the halls with min CHF. He has severe AI and mod MR and we will operate tomorrow.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 26 Nov 2007 11:54 am
Subject: [HSF] Would anyone operate (am I a glutton for punishment?)



Ok, so after my weekend disaster.......

56 year/old - ESRD, failed kidney transplant - makes some urine with severe
proteinuria.  HepC with high viral load, mild fibrosis on biopsy, no
varocise.
Severe AI with dilated root (5.6 cm) with mod/sev MR.  EF ~30-40.
Coronaries ok - mild disease.  Got some treatment for his HepC but is now
pancytopenic - comes in with a WBC of 1-2k, platelets <60k, and a Hct~20.
Gets short of breath walking to the bathroom.  Probably need MV replacement
(tissue??) and either a Bentall or valve sparing root.


-michael
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