Tricuspid replacement

[Bunnyheart]

In 2003 developed SSS (age 50) and syncope....required permanent pacemaker.  Did fine until October 2007 when I developed S.O.B., anasarca, ascites......multiple tests etc.  In Feb. 2008 had a cath....diagnosed with idiopathic restrictive cardiomyopathy.  Early April admitted to local hospital in critical condition , bilat huge pleural effusions required chest tubes ....was hospitalized 5 wks , 2 arrests, then transferred to tertiary care center in Miami....was there 5 wks .  Had 2 other cardiac caths.  Restrictive cardiomyopathy of any type has been ruled out.  Diagnosed with severe tricuspid regurg....pacer wire is pulling on valve but not certain that is the cause.  RV is enlarged and I have mild pulmonary hypertension (40/20).  Was discharged to get recondtioned, then return for tricuspid surgery.  I require oxygen now, pretty much continuous at 1-2 liters.Now the Drs are saying they are not sure if doing the surgery on the valve might make my breathing worse.  I had a PFT....mild restrictive, mild obstructive, severely abnormal DLCO. I was a smoker for many years before getting sick...but I was working full time and not SOB until all this happened. I don't understand why the tricuspid surgery would make my condition worse?? I'm a nurse but I don't get it.  THanks

[Bunnyheart]

I have a pulmonologist, he is the one who did my PFT, but I am not totally confident in him and have considered seeking another oppinion.  The cardiologists at the tertiary center did discuss the possibility of repositioning the pacer lead but they were uncertain whether it would help or not.....and if it didn't I would need emergency tricuspid surgery.  I have considered flying to Cleveland Clinic in Ohio for consultation but my insurance only covers certain hospitals here in FLa....I am already in debt quite a bit from my stay at the University of Miami hospital.(part of the Jackson Memorial Health System).  Would a pulmonolgist be able to advise me whether or not to have the surgery...of is that within the scope of the  cardiovascular surgeon?  I realize there is always risk with heart surgery, but I really do not want to be ventilator dependent.  Thank you for your time.

[Douglas Bogart, MD]

Open heart surgery can sometimes make the lung function worse in the short term related to ventilation/perfusion mismatches that can occur with surgery.  Have they talked about moving the lead to see if the tricuspid regurgitation improves??  You should have a pulmonary evalution by a pulmonary specialist if you haven't had one.

[PikaPika88]

Now I'm considering what my second opinion cardiologist said is true or not....
He said, if now they put in a new tricuspid valve that I can't tell any different.  Normally, they won't repair or fix or replace a tricuspid valve.  It is not important.  I got 2 leads sitting at the right ventricle which were through the tricuspid valve.  I also got SSS.