[HSF] Septic Aortic Valve Endocarditis

[Tea Acuff]

Sounds like good judgement to me. 

Look at it this way. The teeth correlate with the case per your description. Some people like consistency in life and their cases.

tea



----- Original Message ----
From: Tohru Asai <toruasai at belle.shiga-med.ac.jp>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, May 6, 2008 5:41:02 PM
Subject: Re: [HSF] Septic Aortic Valve Endocarditis

Michael
I would agree with Hal's recommendation except one condition. That is the choice of prosthesis. Depending on your patient's condition, multiorgan damage especially with highly damaged kidneys. What I can anticipate is a wild and complicated perioperative care, you may need to be ready to take care of many unexpected complications.

In such a patient, I would choose bioprosthesis rather than mechanical. So you can stop anticoagulation if you need in devastating period. I believe this choice is safer in sick patients even young.

As far as homograft is concerned, I would not even think about it, unless aortic annulus and root is severely destructed. You may encounter a periannular abscess but usually can take care of these with autologous pericardial patch reconstruction. I believe "the smaller, the better" with regard to operative invasion as long as complete debridement is carried out. So I agree with your plan. Good luck! Tell us the outcome.

I am flying from London to NY in AM.
Tohru, the world traveller


Tohru Asai
Professor and Director,Cardiovascular Surgery
Department of Surgery
Shiga University of Medical Science
Otsu Japan
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