[HSF] post AVR morbid obese patient

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Opinion and advice requested for the following case:
52 Y/O female,cushingoid appearance ,hypothyroid on T3,height 145 cm,BW 98 kg,Echo: AS 130 mmHg peak and 78 mean gradient,mild MS,PAP not measured ,TR minimal.Underwent AVR 1 month ago( 19 mm St Jude implanted).Had uneventful postop and discharged at 7 or 8.th day.Readmitted for dyspnea and severe prertibial edema at postop 30.th day.Echo showed posterior fluid of 5 cm thickness INR >10.Followed medically but unsuccessful with low urine output. Taken to operation which was a nightmare.Severe adhesions but fortunately found a plane and aspirated the fluid posterior to LV.Put 3 tubes (one in opened R hemithorax) and closed the wound .Postop he developed Af which could not be converted medically( cordarone).Edema increased .started lasix and finally low dose dopamine . from yesterday on her SO2 decreased to 84-88% on O2.ABG:PH 7.30,PCO2 92,PO2 60.Started noninvasive positive pressure ventilation ( 14 mmHg) ABG:PH 7.31,PCO2 108,PO2 90 .increase to 18 mmHg and decreased FIO2 from 50% to 30 %.Echo: aortic mean gradient 34 mmHg ,moderate MS,PAP 55-60,TR ++,R chambers dilated.
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