[HSF] TVR with liver failure

[Michael Firstenberg]

yes, IV drug abuse - but I do not know (nothing in her records)

interestingly, speaking of records..... all of her medicine H&P/notes/etc
(we are computerized) talk about "mitral valve replacement"

mvr, tvr, whats the difference???


-m


On 3/2/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> 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
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