[HSF] Endocarditis , Septic shock, Drug addict

[Nasser F. Abou'Seada]

That is a heroic job Hal ..... I wish you would have got any photos .... I
wished I could have seen your techniques ...

NFA


On 4/18/08, Hgrmd at aol.com <Hgrmd at aol.com> wrote:
>
> I think it is generally unethical for me to make a life or death decision
> about a drug addict's SBE based on social reasons alone.  In the case you
> described, I suspect the patient wouldn't have survived even if you had
> promptly
> operated.  However, I believe people should be given the benefit of
> the  doubt
> and a second chance.  Nevertheless, if the patient is a  "multiple
> offender",
> which I've seen on occasion, then I would be less likely to  offer surgery
> again.
> You should also not underestimate the recuperative powers of a young
> infected drug addict.  A year ago, I operated on a 47 yo
> Oxycontin  abuser.  My
> partner had operated on him about 10 days earlier.  At the  first
> operation, he was
> found to have a right coronary sinus-RA fistula as well  as aortic
> SBE.  My
> partner did an AVR, debrided and patched the  fistula.  Unfortunately, the
> debridement was apparently inadequate.   When I agreed to reoperate, he
> was
> obtunded on a vent with a trach, on dialysis,  bilirubin of 30, with black
> toes from
> days of high dose Levophed.  He was  spiking temps to 104 with a white
> count
> approaching 30K.  I agreed to  reoperate him because of his age and the
> fact
> that his poor mother kept nearly  24 hr vigil at his bedside.  At
> operation, he
> had a large root abscess  extending into the ventricular septum, the right
> atrium, and involving the  anterior leaflet of the tricuspid valve.  After
> debridement, he had large  VSD, no root, and no tricuspid valve.  I did a
> homograft
> root replacement,  bovine patch closure of the VSD and RA fistula, as well
> as
> TVR (Perimount) and a  Physio around his leaking mitral valve.  Suffice it
> to
> say, after months of  rehab, he completely recovered (he did have to have
> most of his toes  amputated).  His cardiologist told me a few days ago
> that he
> had recently  seen the patient.  He was no longer on drugs and was back to
> work
> as an  accountant.  This is an unusual situation, but it does illustrate
> that
> lots  of people are worth salvaging.
>
> Hal
>
>
>
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