[HSF] Endocarditis , Septic shock, Drug addict

[Michael Firstenberg]

I am still amazed at the patients that you operate on and the ICU resources
you have to work with.

-michael


On 4/18/08, hgrmd at aol.com <hgrmd at aol.com> wrote:
>
> Thanks, Nasser.? Because of his severe hepatic dysfunction, I recall
> spending about 2-3 hours after the pump run getting him dry.? It was
> torture, but ultimately well worth the effort.
>
> Hal
>
>
>
>
>
>
>
> -----Original Message-----
> From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Fri, 18 Apr 2008 12:30 pm
> Subject: Re: [HSF] Endocarditis , Septic shock, Drug addict
>
>
>
> 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
> >
> >
> >
> > **************Need a new ride? Check out the largest site for U.S. used
> > car
> > listings at AOL Autos.
> > (http://autos.aol.com/used?NCID=aolcmp00300000002851)
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