[HSF] 4th rime reop mitral valve

[tdmartin2000 at aol.com]

Only you and the pt can decide whether or not to reoperate, but if you do I think I would opt for either a right or left thoracotomy.

Tom Martin
U of Florida
Gainesville


-----Original Message-----
From: Douville, Chuck <ecdouville at orclinic.com>
To: OpenHeart-L <OpenHeart-L at hsforum.com>
Sent: Sat, 24 May 2008 2:20 pm
Subject: [HSF] 4th rime reop mitral valve



Consult for the members from yesterday. 50 yr old male, former IV drug abuser 
with hepatitis C but none for 4 years, current alcohol user and smoker. History 
dates back to 2004 when he had a homograft root AVR for endocarditis; returned 
to OR for bleeding and IABP but made it through. In 2005 presents with severe MR 
and CHF; undergoes transsternal Mitral repair with quadrangular resection and 
physio ring. Six months later (now 2006) undergoes redo transternal MVR with a 
St. Jude biocor valve for  severe Mitral insufficiency. He now presents to our 
institution for the first time with CHF and has a 23 mm mean gradient across his 
bioprosthetic mitral valve (effective orifice area 1.03) and CHF. EF is 50% with 
mild Aortic insufficiency in the homograft root. He is cirrhotic with an INR of 
1.3, Transaminases are 3X normal and his serum albumin is 2.7 (nl is 3.5 in our 
institution).Serum creatinine is normal but his platelet count is 50K.  No 
ascites on ultrasound, No varices on esophagoscopy. HIs blood cultures are 
negative.
 
His three sternotomies in 4 years have not worked out particularly well. Who 
wants to operate?
 
 
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