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Interventional Cardiology (Expert Forum)
Post MV replacement complication
Answered by
Truman Medical Center
MO
Questions in the Interventional Cardiology forum are answered by medical professionals affiliated with the Truman Medical Center. Topics covered include acute coronary syndrome, angina , atrial fibrillation , cardiac catheterization , cardiomyopathy , drug abuse & cardiac disease, echocardiography , heart failure , hypertension & heart disease , lipid management , minorities and heart disease, peripheral vascular disease prevention, valvular heart disease , women’s heart health, and the warning signs of a heart attack.
Post MV replacement complication
by ghandhik, Oct 09, 2008 04:52AM
85 yr old female. MV replacement 2002. On and off admissions for dyspnoea. Investigated for weight loss for the last six months. All negative.This admission with ?CAP. Fluid restricted in the ward went in for renal impairment and respiratory failure. Required ventilation and CRRT. ECHO transthoracic dilated left atrium smalll welll contracting ventricle LV. NO pulmonary HT and RV normal. ON CPAP5 with FiO2 0.3 Pressure support of 12. Tracheostomy because of failure to come offf the ventilator. ON Carvedilol,Nepro feeds because her Urea goes upto 26mmols when she is not on CRRT for 3 days. At present HR 80s,MAP around 65. Bronchoscopy Normal. CT abdomen normal.
Every time tried for spontaneous breathing becomes tachypneic and hypercarbic and hypoxic. On ventilator with above support very comfortable. But for the Urea rise every 3-4 days requiring one day of CRRT all parameters normal.
Is she having Restenosis. Could it be Ottner's syndrome. TOE is organised but cardiologists feel TTE is OK.Could you help me. Patient is with us for nearly 2 weeks
Every time tried for spontaneous breathing becomes tachypneic and hypercarbic and hypoxic. On ventilator with above support very comfortable. But for the Urea rise every 3-4 days requiring one day of CRRT all parameters normal.
Is she having Restenosis. Could it be Ottner's syndrome. TOE is organised but cardiologists feel TTE is OK.Could you help me. Patient is with us for nearly 2 weeks
Doctor's Answer
by Douglas Bogart, MD, Oct 09, 2008 05:31AM
, Oct 09, 2008 05:31AMTo: ghandhik
One would wonder if the valve has a problem like a pannus formation or thrombus and I would think that a TEE would be of value for this patient. Ortner's syndrome is recurrent laryngeal nerve compression by a large left atrium which gives hoarnsess but not respiratory failure. I would be concerned about the valve.
