[HSF] PO MVR -LA Thrombus

Thu Feb 14 20:35:10 EST 2008

well said Z

NFA

On Thu, Feb 14, 2008 at 6:50 PM, <zzhoumd at pol.net> wrote:

>
> Ani,
>
> There are a lot of differences between giving her a new heart vs a pig
> valve.
>
> Z Zhou
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Ani Anyanwu <anianyanwu at hotmail.com>
>
> Date: Thu, 14 Feb 2008 21:41:36
> To:<openheart-l at lists.hsforum.com>
>  Subject: RE: [HSF] PO MVR -LA Thrombus
>
>
> There are two issues here
>
> First is she stopped taking warfarin. Her active problem now is a clot
> within the LA and the treatment is anticoagulation. She will probably need
> anticoagulation (because of LA thrombus) for at least a few weeks
> post-operatively regardless of what prosthesis we use.
>
> The second issue is she stopped taking ALL her medications. A patient with
> an EF of 25% needs cardiac medications. A valve replacement alone will not
> 'cure' her disease.
>
> For that reason, unless we have a patient who is willing or able to take
> prescription medication regularly, I believe benefit of further surgery will
> be short-lived. This patient has heart failure and the therapy is multimodal
> - if one of those modes (oral medicines) is missing then treatment will not
> work.
>
> We exercise this discretion, for example, in transplantation where we
> would not do a transplant on anyone who is unwilling (e.g. compliance) or
> unable (e.g. poverty) to comply with a strict post transplant medication
> regime. On the other hand, if the post-op medication regime was less
> exacting (such as for aortic stenosis) then I would fully agree with
> offering life-saving surgery to a non-compliant patient.
>
> Ani
>
>
>
>
>
>
> > Date: Thu, 14 Feb 2008 14:26:32 -0600> From: nfaabouseada at gmail.com> To:
> OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] PO MVR -LA Thrombus> CC:
> > > "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)."> > How much
> likely is "likely" here ?? especially with placement of a> non-coumadin
> requiring bioprosthesis ??> > 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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