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- Title
POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING SURGICAL CORRECTION FOR ORGANIC TRICUSPID VALVE DISEASE. CLINICAL CASE PRESENTATION.
- Authors
Moise, Bianca; Mincu, Dana; Popescu, B. A.; Călinescu, Miruna; Ginghină, Carmen
- Abstract
Introduction. Tricuspid regurgitation is a disorderfrequently associatedwith left-side heart disease or pulmonary hypertension, which in turn cause dilation of the right ventricle and tricuspid annulus, while primary, organic disease is a rare finding.. Methods- A 57 year old female presented in our department with fever, chills and malaise, three weeks after tricuspid valve repairvia limited right anterolateral thoracotomy. Abnormal laboratory tests included increased ESR (ESR=97 mm/h) and fibrinogen (876 mg/dl) and leukocytosis with neutrophilia.2-D transthoracic echocardiography described dilation of the right cavities, with mild right ventricular dysfunction, mild tricuspid regurgitation, circumferential pericardial effusion (the most 10 mm anterior of the right ventricle). We noticed a small non-oscillating mass attached on the atrial side of the tricuspid valve which would suggest either a vegetation or a particular postoperative aspect. Results -The presence of three minor criteria - predisposing cardiac disease, unexplained persistent fever and one blood culture positive for Enterococcus, raised the suspicion of infective endocarditis. The patient's evolution while on antibiotics was variable. The absence of clinical improvement, persistence of inflammatory syndrome and normal procalcitonin levels suggested a different diagnosis. Conclusions: Despite the absence of specific clinical features (thoracic pain and friction rub) and negative anti-myocardial antibodies, our data suggest postpericardiotomy syndrome (PPS) as a possible diagnosis. The patient's evolution on corticosteroid therapy was favorable, with rapid remission of the inflammatory syndrome and clinical improvement. Recurrence of PPS occurred each time after ceasing systemic corticosteroid therapy during the follow up period of one year.
- Subjects
AORTIC valve insufficiency; TRICUSPID valve diseases; PULMONARY hypertension; FIBRINOGEN; RIGHT heart ventricle
- Publication
Romanian Journal of Functional & Clinical, Macro & Microscopical Anatomy & of Anthropology / Revista Româna de Anatomie Functionala si Clinica, Macro si Microscopica si de Antropologie, 2015, Vol 14, Issue 2, p281
- ISSN
1583-4026
- Publication type
Article