[HSF] endocarditis

[hgrmd at aol.com]

I would certainly have whatever left assist device you've got ready to use.

Hal
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "gustavo abuin" <gabuin at intramed.net>

Date: Sun, 9 Mar 2008 23:32:27 
To:<OpenHeart-L at lists.hsforum.com>
Subject: Re: [HSF] endocarditis


Hal. Do you suggest to use directly the centrifugal pump instead to try a 
difficult-impossible weaning for the pump?
It´s an option. I will try a weaning with inotropes milrinone-noradrenaline 
ONCE. If the patient says "what are you talking about gustavo" then I will 
place a left assistance.
Continue  reading suggestions, Thanks.
gustavo.
----- Original Message ----- 
From: <hgrmd at aol.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Sunday, March 09, 2008 7:29 PM
Subject: Re: [HSF] endocarditis


> Gustavo,
>  With an EF that bad and presumably normal coronaries, I doubt your 
> patient would survive the clamp time I would need to correct all the 
> problems you describe.
>
> Hal
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: "gustavo abuin" <gabuin at intramed.net>
>
> Date: Sun, 9 Mar 2008 10:38:11
> To:<OpenHeart-L at lists.hsforum.com>
> 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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