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Heart Disease (Expert Forum)
COMPLICATIONS AFTER 3RD MITRAL VALVE REPLACEMENT (TRICUSPID REPAIR)
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COMPLICATIONS AFTER 3RD MITRAL VALVE REPLACEMENT (TRICUSPID REPAIR)
by shell shell, Oct 09, 2001 12:00AM
HISTORY: FEMALE, AGE 46, MITRAL VALVE STENOSIS AND REGURITATION SINCE 1984. FAILED OPEN MITRAL VALVE REPAIR JAN 1985 followed by MV REPLACEMENT JULY 1985 (29MM WESSEX biological). MV REPLACEMENT (MOSAIC BIOPROSTHESIS) AND TRICUSPID REPAIR (32MM COSGROVE RING) IN 2000.
The 3rd op: Right atrium was opened and mv approached via septum, extremely difficult access due to dense adhesions, mv completely disorganised, heavily calcified disintigrating with touch and completely incorporated in surrounding tissue. The right atrium disintigrated becoming almost completely detached from the inferior venae cavae, and was reconstructed using two no-react pericardial patches and so was the atrial septum which has a residual shunt.suffered stroke (paralysed left arm)
post-op symptoms: SEVERE CONTANT GRIPPING PAIN around abdomen along length of spine, worsens on standing, moving, passing stools. ABDOMINAL DISTENTION WITH 3-FINGER BREADTH HEPATOLOGY raised bilirubin MASSIVE ASCITES OEDEMA IN ABDOMEN AND LEGS despite 80mg frusemide, CHRONIC CONSTIPATION almost no bowel movements without laxatives, CHRONIC INSOMNIA.
Has inferior vena cava diamenter of 1.5cm.
please could you tell me if her condition could possibly be due to:
1 right-heart failure? 2 stenosed vena carva? 3 pulmonary hypertension? 3 incisional hernia causing intestinal obstruction? 4 intestinal ischemia? 5 portal hypertension? 6 celiac artery compression syndrome? 7 abdominal angina?
No room for proper Q's please say if it is likely to be her heart, blood vessel or something else. THANKYOU.
The 3rd op: Right atrium was opened and mv approached via septum, extremely difficult access due to dense adhesions, mv completely disorganised, heavily calcified disintigrating with touch and completely incorporated in surrounding tissue. The right atrium disintigrated becoming almost completely detached from the inferior venae cavae, and was reconstructed using two no-react pericardial patches and so was the atrial septum which has a residual shunt.suffered stroke (paralysed left arm)
post-op symptoms: SEVERE CONTANT GRIPPING PAIN around abdomen along length of spine, worsens on standing, moving, passing stools. ABDOMINAL DISTENTION WITH 3-FINGER BREADTH HEPATOLOGY raised bilirubin MASSIVE ASCITES OEDEMA IN ABDOMEN AND LEGS despite 80mg frusemide, CHRONIC CONSTIPATION almost no bowel movements without laxatives, CHRONIC INSOMNIA.
Has inferior vena cava diamenter of 1.5cm.
please could you tell me if her condition could possibly be due to:
1 right-heart failure? 2 stenosed vena carva? 3 pulmonary hypertension? 3 incisional hernia causing intestinal obstruction? 4 intestinal ischemia? 5 portal hypertension? 6 celiac artery compression syndrome? 7 abdominal angina?
No room for proper Q's please say if it is likely to be her heart, blood vessel or something else. THANKYOU.
Doctor's Answer
by CCF-M.D.-CRC, Oct 10, 2001 12:00AM
Dear shell,
This is a very complex case and I'm not sure I'll be able to help much over the internet. Certainly right heart failure can cause many of the symptoms you mentioned as could a stenosed vena cava and less likely pulmonary hypertension. The other things you mentions could cause abdominal symptoms but I'm not sure they fit with her case. An echocardiogram would be very helpful as would a right heart cath. If her symptoms are all due to heart failure then medical management would be first line treatment and then consideration of heart transplant if she continued to deteriorate and was a suitable candidate.
This is a very complex case and I'm not sure I'll be able to help much over the internet. Certainly right heart failure can cause many of the symptoms you mentioned as could a stenosed vena cava and less likely pulmonary hypertension. The other things you mentions could cause abdominal symptoms but I'm not sure they fit with her case. An echocardiogram would be very helpful as would a right heart cath. If her symptoms are all due to heart failure then medical management would be first line treatment and then consideration of heart transplant if she continued to deteriorate and was a suitable candidate.
