[HSF] Anticoagulation after biological valve or repair

[DukeB60 at aol.com]

I just got a call from the ED and a  cardiologist regarding a post-op. third 
time redo aortic valve who  presented today with hypotension.  He had a 
previous AVR a few years ago  with subsequent prosthetic endocarditis and got a 
tissue valve replacement only  to develop a large perivalvular leak and 
subvalvular aneurysm for which I was  consulted.  He has very, very severe bullous 
emphysema with his lungs  touching in the midline for six inches before you could 
even get to the heart by  preop CT.  I did his redo, redo AVR a couple of weeks 
ago and by some  miracle was able to dissect down to the heart and aorta 
without a hint of an air  leak and replaced his valve and repaired a subvalvular 
aneurysm bulging into the  LA due to a disruption of the Aorto-Mitral 
continuity.  He remarkably did  very well and was discharged only to return today with 
hypotension and a CT  showing a large mediastinal hematoma causing tampanode.  
Oh by the way, his  INR is 6.  I'm waiting right now to get some FFP infused 
then evacuate the  hematoma and deal with those lungs again.  I'm not sure why 
he is on  Coumadin.  It only reinforces the points made previously that the 
morbidity  of the coumadin outweight the risk of CNS events but the cards do 
love  coumadin.
 
                                                                              
                              Ed
 
Edward P. Raines, M.D., J.D.
BryanLGH  Cardiothoracic Surgery
BryanLGH Medical Center East 
1600 South 48th  Str.
Lincoln, Nebraska 68506
Office: 402-481-8430
Cell:  402-730-9242
Fax: 402-481-8429





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