title: A high risk critical mitral valve stenosis with emergency management at Apollo Hospitals Dhaka.
abstract: Heart valve surgery in high-risk patients with severe jaundice, congestive hepatomegaly and renal impairment is associated with considerable morbidity and mortality. Without operation the consequences are invariably grave. A 35 years old gentleman with congestive cardiac failure was initially treated in coronary care unit (CCU). Mitral valve area was 0.5cm², pulmonary arterial systolic pressure (PASP) was 110mmHg, serum bilirubin was 20mg/dl, SGPT & SGOT were 1024iu/l and 1027iu/l respectively. Serum creatinine was 3.35mmol/l. Serum bilirubin gradually diminished to 3.1mg/dl after 12 days treatment in Coronary Care Unit but next day it increased to 3.6mg/dl. Mitral valve was replaced on an emergency basis. Echocardiogram on the 5th post operative day showed well functioning prosthetic mitral valve in situ. Serum bilirubin decreased to 2.2mg/dl, SGPT, SGOT and serum creatinine to 43iu/l, 40iu/l and 1.34mmol/l respectively. After 8 weeks of postoperative follow up his serum bilirubin decreased to 0.8mg/dl.
authors.affiliation: Dr Nuruddin Mohammod Zahangir, Senior Registrar, Department of Cardiothoracic Surgery, Apollo Hospitals, Dhaka, Bangladesh.
authors.forename: N M
authors.initials: NM
authors.lastname: Zahangir
authors.forename: K Z
authors.initials: KZ
authors.lastname: Hoque
authors.forename: M H
authors.initials: MH
authors.lastname: Khan
authors.forename: M A
authors.initials: MA
authors.lastname: Haque
authors.forename: M Z
authors.initials: MZ
authors.lastname: Haider
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000032:analysis; D004632:Emergency Medical Services; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000473:pathology / Q000601:surgery*
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin