[HSF] endocarditis

[gustavo abuin]

Thanks Tom. The patient is with dobutamine with no simptoms of HF.

----- Original Message ----- 
From: <tdmartin2000 at aol.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Sunday, March 09, 2008 11:28 PM
Subject: Re: [HSF] endocarditis


>
> 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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