[HSF] TVR with liver failure

[Prasanna Simha M]

Whats an IVDA ? Intravenous drug abuser ?
Prasanna

On Sun, Mar 2, 2008 at 9:03 PM, Michael Firstenberg <msfirst at gmail.com> wrote:
> I know we talk about this frequently - and the key is congestion vs
>  cirrhosis and usually we see TR....but
>
>  I am seeing a 51 woman tomorrow who while getting worked up for a liver
>  transplant was found to have tricuspid prosthetic valve stenosis (dont know
>  anything about when/where/type/etc but probably remote IVDA).
>
>  TV gradient of 14mmHg, stenosis, with enlarged RA on echo.
>  min CAD on cath from 2006
>  Recent admission for liver encephapathy (Ammonia 85!)
>  Hep C
>  EGD recently shows mild varices (and gastric ulcers)
>
>  Creatinine: 1.3-2.2
>  Bili 2.5/1.0
>  Albumin: 2.7
>  Alk Phos: 62
>  ALT/AST: 107/188 (give or take over multiple tests)
>  INR: 1.4 (was 2.2, but I think she was on Coumadin for afib/flutter)
>
>  ANA positive
>  CA 19-9 120 (normal 0-35, whatever that means??)
>  No liver bx that I can find
>  CT scan: "   The liver is nodular with hypertrophy of the caudate and
>  widening of
>     the fissure consistent with cirrhosis. The spleen is enlarged and
>     there are multiple splenic varices and perigastric varices. " (from nov
>  07)
>
>  MRI: "Cirrhosis, splenomegaly and extensive varices, consistent with
>     development of portal hypertension"
>
>
>  my thoughts are very high risk for a toe nail clipping......let alone a
>  re-op TVR
>  (I could put in a mechanical valve to help out our friendly liver transplant
>  surgeons)
>
>
>  -michael
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-- 
Prasanna Simha M