[HSF] PO MVR -LA Thrombus

Fri Feb 15 10:47:19 EST 2008

Thank You Sir ...
I'm grateful for you remembering my name .... all the time you respond to my
threads in names of Ani ... or Prasanna ....... a double credit for me by
all ways ... !

Yours

Nasser

On Fri, Feb 15, 2008 at 1:11 AM, <rwmfglycar at aol.com> wrote:

> Nasser, I am in agreement with the consensus that you have detected in
> this series of answers. For thrombosed mechanical valves the current
> experience is that thrombolysis has been shown to work well with far less
> risk of cerebral embolic events than had been feared. The fresher the clot ,
> i.e. the more recent the event, the better it works. If pannus has
> developed through fibrous organisation of the clot it doesn't work.
> If for any reason you are confined to use of anticoagulation alone, the
> patient's natural thrombolysis will need to do the work and it will take
> longer. Again, the fresher the clot the better the result. The rapid return
> of movement to the leaflets is encouraging.
> I suspect that this patient is in atrial fibrillation and has a large
> atrium making her vulnerable to a atrial clot formation?in addition to small
> platelet /fibrin?clots in the region of the leaflets. Another issue is what
> the original orientation of the valve was. If transverse the movement of the
> posteriorly aligned leaflet may have been less than complete making it more
> vulnerable to absence of anticoagulation.
> The social issues in cases like this need to be anticipated and are
> extremely important. In the developing world of the Bronx the notion that
> mechanical valves are the right choice for younger patients was not correct
> because of the disorganised lives that some poor people inevitably lead.
> I would not operate for the LA thrombus at the present time and maybe
> never. I have in my career?replaced ?a mechanical? with a biological valve
> electively because of persistent recurrent thromboembolic complications,
> Bob
>
>
>
> -----Original Message-----
> From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Thu, 14 Feb 2008 9:44 pm
> Subject: Re: [HSF] PO MVR -LA Thrombus
>
>
>
>  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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