AW: [HSF] Prosthetic Valve Endocarditis in setting of severe LVdysfunction

Thu Sep 13 15:32:19 EDT 2007

Simply speaking it is the Dor Operation.

SVR I think is short for surgical ventricular restoration (or reconstruction or remodelling depending on which source you look). I am not quite sure how or where the term arose but in essence I believe it is another name to make the Dor operation look sexier and more marketable. It is sold to the public, at least in the US, as a cure for heart failure and many centers advertise this procedure on their website. SVR is I believe on of Tea's interests so he will probably shed more light on the origins of the terminology and the current status of this operation.

Apologies for the abbreviation which I had simply taken from Tea's earlier response.

Ani

> From: battr at medizin.uni-leipzig.de> To: OpenHeart-L at lists.hsforum.com> Subject: AW: [HSF] Prosthetic Valve Endocarditis in setting of severe LVdysfunction> Date: Thu, 13 Sep 2007 16:19:38 +0200> CC: > > Sorry, what is SVR? > > -----Ursprüngliche Nachricht-----> Von: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Ani Anyanwu> Gesendet: Donnerstag, 13. September 2007 14:52> An: openheart-l at lists.hsforum.com> Betreff: RE: [HSF] Prosthetic Valve Endocarditis in setting of severe LVdysfunction> > If the lesion involves the aortic annulus where it meets the trigone then debridement will likely require a Bentall to reconstruct.> > I know you are a believer in the SVR but I think in reality there are few patients in whom it is a solution. Thus far I have never seen a patient referred for transplant for whom SVR is a reasonable option. Would you advocate SVR in patient with severe RV dysfunction and dilatation and global LV dilatation with all major regions hypokinetic, akinetic or dyskinetic who has a prosthetic mitral valve? I suppose you could do an SVR on the RV too but doubt that will help either. Also in reality I suspect his cardiomyopathy is non-ischemic as it is out of proportion to his single vessel CAD (LAD occluded in midcourse).> > I also have my views on the relevance of ICD as sudden death is not the commonest mode of death in these patients, however if you read the literature it would seem that one life is saved for 16 ICDs placed (not a fair statistic though as some lives are saved numerous times over and over again so the true lives saved may be much less).> > Ani> > > > > Date: Wed, 12 Sep 2007 20:12:40 -0700> From: tacuff at swbell.net> Subject: Re: [HSF] Prosthetic Valve Endocarditis in setting of severe LV dysfunction> To: OpenHeart-L at lists.hsforum.com> CC: > > Why would you need to do a Bentall for this? Why or why not was SVR not a solution instead of ICD other than the usual brainless protocols and guidelines?> tea> > > ----- Original Message ----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Wednesday, September 12, 2007 9:44:15 AM> Subject: [HSF] Prosthetic Valve Endocarditis in setting of severe LV dysfunction> > > Would be interested in forum members opinion on this case.> > This 58 yr old with hypertensive nephropathy, on dialysis for five years and on waiting list for kidney transplantation first presented to us December 2005 with an acute MI. Catheter showed occluded LAD which caused a massive anteroseptal MI with severe LV dysfunction. Echo showed mitral valve endocarditis with large vegetation. Cultures grew an enterococcus. Coronaries were otherwise pristine with no collateral LAD filling suggesting the occlusion was secondary to embolisation from the mitral. He underwent MV replacement and vein graft to LAD, also tricuspid repair. LV dysfunction however persisted following surgery and heart continued to remodel with dilated 7cm LV and LVEF ranging 10 to 15%. He was evaluated for heart transplant at another institution earlier this year but turned down (i think because he was too well - VO2 max 23). LV dysfunction was managed medically and for most part he is in NHYA II.> > Patient now admitted under our care because of prosthetic valve endocarditis. Cultures are positive for Staph Aureus sensitive to methicillin and echo shows probable abscess around trigone and may involve aortic annulus around non-coronary cusp. There is no valvar incompetence (of either aortic or mitral). Infection may have been triggered by a recent transvenous defibrillator (2 months ago) or a dialysis access cathether. Has been on antibiotics in outside hospital for 3 weeks before being transferred to us this week. Transesophageal echo here confirms EF around 10%, also severe RV dilatation and dysfunction. There is also echodensity at tip of RV defibrillator lead and previously described abscess but stable prosthesis. CT Angio shows patent vein graft. Right heart cath is notable for a wedge of 34, PA 40/30, RA 10, SVO2 50%. Patient is stable, no active heart failure and sepsis well controlled on antibiotics. > > Surgical therapy for this condition we expect will require radical debridement of trigone, redo MV replacement, likely Bentall, also will explant defibrillator and dialysis catheter. Patient is likely to bleed and require transfusions hence compounding existing RV dysfunction. > > Considering that this is not an operation for heart failure, but surgery in the midst of heart failure, it will invariably worsen rather than improve function of the heart; I would be keen to hear from forum members how they would deal with this case. Would anybody operate and at what do you think is the chance of success (by success I do not mean our usual 'extubated the next morning' criteria' but return to good quality of life) and at what risk of operative mortality? > > My current leaning is to offer this patient combined transplantation of the heart and kidney as the strategy most likely to result in mid-term survival - would also be keen to hear thoughts from transplant surgeons and others about this option.> > Thanks> > Ani> _________________________________________________________________> 100ʼs of Music vouchers to be won with MSN Music> https://www.musicmashup.co.uk_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and> disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> _________________________________________________________________> 100’s of Music vouchers to be won with MSN Music> https://www.musicmashup.co.uk> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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