[HSF] PO MVR -LA Thrombus

[Nasser F. Abou'Seada]

Dear Ani
Sorry ... but I am not getting what you mean ...

- are you implying that a psychiatric patient should be deprived of a life
-improving procedure ? .. even if she is denied such a procedure ... she
might not die cause of the complications ... but rather stay crippled - in
hemi-plegia ... quadri-plegia" for the rest of her life ... exerting extra
burdens of the health providing resources and the surrounding society.. !
- would not 3 weeks under observation be a critical period increasing the
risk for some inevitable complication to happen, that can be avoided by such
a proposed procedure ?? ... is that your personal opinion or else is it
backed by literature or EB Practice ?

the patient is ill .... needs treatment .... whether her illness is cardiac,
psychiatric or else .... is it a waste of resources to perform a procedure
that requires no further coumadins .... ???? .... I wonder how would that
compare to inserting an LVAD or BiVAD in a severely ill patient whom you are
anticipating very minimal hope for recovery in the following few months
..!!! ...

I do agree with you that the reason behind what happened should be addressed
.... yet do you think her well-being should be compromised in these 3 weeks
??? ..

I am not critisizing your opinion .... au contraire .... I am looking
forwards for your - for sure enriching- detailed analysis, formulation and
evaluation of the problem ...

NFA


On Thu, Feb 14, 2008 at 12:11 PM, Ani Anyanwu <anianyanwu at hotmail.com>
wrote:

> > > She underwent MVR 2 months back and stopped all her medications >
> >including warfarin for 20days.
>
>
> How will further surgery solve this? A patient who stops all her
> medication within a month of open heart surgery? I would say get a
> psychiatrist. If she does not have any psychiatric disorder or a good reason
> for not taking her medication then whatever operation you do, her life
> expectancy will likely be limited. There is only so much we can do as
> surgeons, the patient has their part to play too - it looks to me that this
> patient either lacks the ability or desire to be compliant with medical
> instructions.
>
> I would address the reason behind why she didnt take her medications for 3
> weeks - if it is a reversible one then I would operate - if the reason is
> still active then this surgery will likely end up the way of the last one
> (even if you place a bioprosthesis).
>
> Ani
>
>
>
>
>
> > Date: Fri, 15 Feb 2008 00:02:32 +1000> To: OpenHeart-L at lists.hsforum.com>
> From: benjamin.bidstrup at bigpond.com> Subject: Re: [HSF] PO MVR -LA
> Thrombus> CC: > > >We have a patient admitted with LA thrombus.> > > > She
> underwent MVR 2 months back and stopped all her medications > >including
> warfarin for 20days. She was seen at some other hospital > >in cardiogenic
> shock and was intubated. Echo showed LA thrombus and > >one leaflet of
> carbomedics valve not moving normally.> > > > She was transferred to us
> after 2 days stay in that hospital . > >Repeat echo at our hospital showed
> normally functioning vlave , > >large LA thrombus and EF 25%. She was in
> hepatic[ bilirubin 18] , > >and renal failure[creatinine 2.5] at admission
> which improved over > >next 2 days and was extubated.> > > > Should we
> operate her for LA Thrombus?> >> > > >--------------------------------->
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> >-----------------------------------------> Continue warfarin. It should
> disappear.> > -- > Ben Bidstrup FRACS FRCSEd FEBCTS> Consultant
> Cardiothoracic Surgeon> _______________________________________________>
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