AW: [HSF] PO MVR -LA Thrombus

[Nasser F. Abou'Seada]

So Dave ...
 what do you conclude to be done now ?
NFA

On Fri, Feb 15, 2008 at 12:55 PM, David Harris <drdharris at yahoo.co.uk>
wrote:

> Roberto,
>
> I agree with your concern.
> I have seen similar patients present the same way,
> then stabilise, and the echo show one leaflet not
> moving. This is a case to move STAT. I have seen one
> leaflet thrombus progress to total fixed closure of
> the valve and instant pulmonary oedema within hours.
>
> This patient is possibly a bit different. The valve
> was done recently, so the valve does not have to come
> out because of chronic pannus which will re-obstruct
> and cause chronic clot. There is documented
> non-compliance, so we know there is fresh clot. The
> latest echo reported that the leaflets were moving ok.
> I would of course question this, and re-assess with
> TEE. There remains the question that the implantation
> technique was wrong, and the leaflet is impinging
> somewhere. This should always be kept in mind, as I
> have seen defaulters go for months on end without
> problems!!
>
> David
>
> --- "Dr. Roberto Battellini"
> <battr at medizin.uni-leipzig.de> wrote:
>
>  > Something is happening with the valve, and if she
> > was in shock, and one
> > leaflet was not moving normally, something is wrong.
> > Besides she has a
> > thrombus. I would think in a TEE and if you have
> > doubts of the functioning,
> > very soon in a reoperation before the patient
> > decompensate and dies like the
> > one with the Konno Byzantine(sorry) discussion.
> > -Roberto
> >
> > -----Ursprüngliche Nachricht-----
> > Von: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] Im
> > Auftrag von yadav del
> > Gesendet: Donnerstag, 14. Februar 2008 13:10
> > An: OpenHeart-L at lists.hsforum.com
> > Betreff: [HSF] PO MVR -LA Thrombus
> >
> > 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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>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon
> Suite 207
> Kuils River Private Hospital,
> PO Box 1200, Kuils River, 7579, Cape Town, South Africa.
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