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Right before Christmas I was asked by the ER physician to see this patient. He was a young man with a 14-year-old bioprosthetic aortic valve. The ER physician said he wasn't looking well, and I could sense the physician was nervous (thread 1/5).
I had the echo tech do a formal study immediately, while I drove in to meet him there. The patient's white count was elevated, shock liver failure, shock renal failure, critical aortic stenosis, moderate to severe regurgitation, EF 20%
I quickly called the surgeon, and he came in immediately, and says to me, "I want you to call the interventionalist to do an emergency TAVR." The interventionalist was on holiday, but he came in anyway. The TAVR was done in an hour.
The patient did have endocarditis (MSSA). The patient who was probably a few hours from death, not only survived, but is continuing to progress well. The surgeon plans to take out both valves and place a (probable) mechanical valve in the future.
It amazes me to realize that the quick thinking and action of every person who was involved with this case. Any misstep or delay in care would have resulted in his demise. (/thread)
