[HSF] 4th rime reop mitral valve

[Michael Firstenberg]

what are you going to do when he needs his homograft redone in a  
couple of years?
anyone vote to take that out and put in a mechanical valved conduit?
(granted it is not that much of a problem now.....)

-michael

On May 24, 2008, at 9:11 PM, tdmartin2000 at aol.com wrote:

> 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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