[HSF] TVR with liver failure

[Ani Anyanwu]

Like  said before I would first consider catheter based intervention. If tissue valve examine options of balloon valvuloplasty, if mechanical consider thrombolysis. 
 
Next I would get a right heart catheterization to convince myself there is a clinical problem here. The dilated RA my be reflective of the primary disease and may not mean there is significant stenosis now. If venous hypertension is not severe I would probably ignore and not offer any surgery.
 
If patient does indeed have severe stenosis, I would not operate as an isolated procedure. However, with several guns to my head and if the patient is young and no other comorbidity, I may succumb, as we do, and rereplace this through a thoracotomy - however there must be several guns pointing and the bearers must be sharp shooters who take no prisoners alive.
 
My preferred approach here would be to offer them a combined procedure. If they are committed to saving the patient they will take the option, but more likely than not the patient will be labelled inoperable on all fronts which is probably the most appropriate. I do not think they would be prepared to risk a transplant death as a reop valve not necessarily straightforward. We have done primary CABG as combined procedure with liver transplant but never a reoperation.
 
Ani
 
 



> From: msfirst at gmail.com> Subject: RE: [HSF] TVR with liver failure> Date: Sun, 2 Mar 2008 17:45:03 -0500> To: OpenHeart-L at lists.hsforum.com> CC: > > Ok stop skirting around the issue> > Would anyone operate?> > Michael Firstenberg <msfirst at gmail.com>> > -----Original Message-----> From: Hgrmd at aol.com> To: OpenHeart-L at lists.hsforum.com> Sent: 3/2/2008 5:28 PM> Subject: Re: [HSF] TVR with liver failure> > Tom,> Your choice of porcine valve for the tricuspid position is likely the best > one. To be honest, I've a very limited experience with tricuspid > replacement, and have probably done less than 10 in my career. I have opted for a > pericardial prosthesis simply because their durability seems better in the aortic > and mitral positions. However, anybody requiring a tricuspid replacement is > pretty unlikely to outlive the prosthesis.> > Hal> > > > **************Ideas to please picky eaters. Watch video on AOL Living. > (http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/> 2050827?NCID=aolcmp00300000002598)> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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