[HSF] Recurrent prosthetic TV endocarditis

[Ani Anyanwu]

> harsh, I think she has abdicated her role in this decision process by her continued IVDA.
> 
> John
 
A patient never abdicates their role in decision making process unless they are mentally incapacitated or unconscious.
 
Her decision may well be that she does not want further surgery, or does not want her valve left open with TR, or wants another try at replacement and wants to try reform her ways, or maybe she wants valve excised as she will not reform her ways - we must take what such a patient wants into consideration before deciding what we do.
 
Ani
 
 
 



> Date: Sat, 8 Mar 2008 20:45:24 -0800> From: streitman at yahoo.com> Subject: RE: [HSF] Recurrent prosthetic TV endocarditis> To: OpenHeart-L at lists.hsforum.com> CC: > > Ani,> > She has not had heart cath yet. She had normal> coronaries 6 mos ago. No mention was made with> regards to PA pressures by TTE or TEE on the report> (probably lack of TR jet with prosthetic valve). I> have not seen the patient yet but without sounding too> harsh, I think she has abdicated her role in this> decision process by her continued IVDA.> > John> > --- Ani Anyanwu <anianyanwu at hotmail.com> wrote:> > > With the recurrent pulmonary emboli, what are the PA> > pressures now? If pulmonary hypertension probably> > limits options as may not tolerate valvectomy.> > > > Also what does the patient want?> > > > Ani> > > > > > > > > > > > > Date: Sat, 8 Mar 2008 12:49:36 -0800> From:> > streitman at yahoo.com> To:> > OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF]> > Recurrent prosthetic TV endocarditis> > HS forum:> >> > I present a case for advice:> > 43 y/o female I> > operated on 6 months ago with TV> endocarditis (OSSA> > due to IV drug use). She initially> presented with> > septic pulmonary emboli and severe TR> with> > involvement of all three leaflets with 2 separate>> > 1.5-2 cm vegetations. This required resection and>> > replacement with a 33mm Perimount valve. She has> > been> recently readmitted back to her old ways with> > new> recurrent septic pulmonary emboli and an> > impressive> vegetation on her prosthetic valve with> > OSSA in her> blood once more.> > >From an ethical> > standpoint I question re-operation. > My question> > for the audience is what options do I have>> > (resection w/o replacement, re-replacement, etc).> > Are> there any options for tissue only replacement> > akin to> a stentless valve for this patient? Thanks> > for your> input. > > John> > John E Streitman, M.D.>> > Cardiovascular Surgeon> Firsthealth CVT Surgeons>> > streitman at yahoo.com> > >> >> ____________________________________________________________________________________>> > Looking for last minute shopping deals? > Find them> > fast with Yahoo! Search.> >> http://tools.search.yahoo.com/newsearch/category.php?category=shopping>> > _______________________________________________>> > 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>> > -----------------------------------------> >> _________________________________________________________________> > Share what Santa brought you> >> https://www.mycooluncool.com_______________________________________________> > 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> > -----------------------------------------> > > > > John E Streitman, M.D.> Cardiovascular Surgeon> Pinehurst, NC> streitman at yahoo.com> > > ____________________________________________________________________________________> Never miss a thing. Make Yahoo your home page. > http://www.yahoo.com/r/hs> _______________________________________________> 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> -----------------------------------------
_________________________________________________________________
Telly addicts unite!
http://www.searchgamesbox.com/tvtown.shtml