[HSF] PO MVR -LA Thrombus

[Nasser F. Abou'Seada]

Dear Bob ...
I am begging your opinion regarding the seemingly prevalent consensus !!! of
continuing anti-coagulation hoping the clot -or is it a THROMBUS??-  will
dissolve .... in the setting of a mechanical valve prosthesis ....... how do
you see the risk of current thrombo-emboli ... residual thrombus left
embolizing later ? .... ineffectiveness of the "thrombosed" valve -leaflet
at least- or the hinge points ?? ... and what is your advise regarding the
cost of the second operation? in contrast to "at least- a fortnight
hospitalization period ?? .......
your experience based evaluation is immensely directing the flow of thoughts
...!!

NFA

On Thu, Feb 14, 2008 at 8:30 PM, Prasanna Simha M <prasannasimha at gmail.com>
wrote:

> If she is so sick continue thrombolysis and keep her anticoagulated
> aggressively. I have seen massive clots like that disappear but it takes
> up
> to 6 weeks.If by that time it doesn't then consider surgery.Time and again
> we have seen thsi problem with patients unwilling for a second surgery and
> with resolution of the clot so much so that if it is a large adherent clot
> the thrombolic risk is low enough that we now wait, thrombolyse for 48 -72
> hours and anticoagulate aggressively (to allow natural innate thrombolysis
> to continue)
> Prasanna
>
> On Thu, Feb 14, 2008 at 5:40 PM, yadav del <yadavluck at yahoo.com> wrote:
>
> > 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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> --
> Prasanna Simha M
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