[HSF] Endocarditis , Septic shock, Drug addict

Fri Apr 18 23:04:44 EDT 2008

Fortunately, God takes the decison regarding life and death.
We can always help doing our job.
We have to stratify patient risk and go ahead or not.
gustavo.

----- Original Message ----- 
From: "Michael Firstenberg" <msfirst at gmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Friday, April 18, 2008 4:28 PM
Subject: Re: [HSF] Endocarditis , Septic shock, Drug addict

>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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