[HSF] endocarditis

[tdmartin2000 at aol.com]

Gustavo
If no abscess then I would agree with the plan, but if there is an annular abcess I would consider using a homograft. As for the mitral, I would opt for a valvuloplasty with an appropriate size ring, downsizing only 1 if any. With that poor of a ventricle I would most likely place the pt in the ICU several days preop with a swan and treat for heart failure and trying to optimize the PA pressures which I am sure are elevated. We usually use milrinone and it would be started prebypass and we would insert a IABP prior to coming off pump. Some type of ventricular assist device would be a consideration if we thought the pt was a transplant candidate, but with an active infection that would rule them out, at least here.
good luck

Tom Martin
U of Florida
Gainesville

-----Original Message-----
From: gustavo abuin <gabuin at intramed.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 9 Mar 2008 9:38 am
Subject: [HSF] endocarditis


Dear members.?
We have a 28 year old patient with an aorto right ventricular fistula, subaortic VSD (both small), aortic insufficiency, aortic endocarditis, moderate central mitral insufficiency with no structural disease of the valve and 18% of EF, 88 of end diastolic diameter.?
no pulmonary hypertension, no RV failure, no organ disfunction.?
The patient is with antibiotics and low dose of dobutamine, with no fever, no acute signs of cardiac failure.?
I will place him on the OR next wenesday.?
I plan to replace the aortic valve, close the defects with a patch or maybe some pledgettes stiches.?
The question about the mitral valve in order to treat the mitral annullus and cardiac failure:?
-pericardium annuloplasty?
-annuloplasty up to a perfect competence with a proper sized mitral ring.?
-annuloplasty with a 2-3 downsize mitral ring.?
-mitral replacement??
?
The question about comming offpump:?
combination of inotropics?
centrifugal pump directly??
?
What do you do in a routine basis in this cases??
?
Thanks in advance.?
gustavo.?
?
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