Hello,

Thank you for your query at doctorspring.com.
There is a lot of discrepancy in the reports that you have attached.
Firstly, the echo report of 4/11/13 suggests that there are vegetations on the aortic valve and the AR is mild.
This indicated that patient has infective endocarditis if the echo report is correct.
Still no antibiotics were given as per the records.
Also there is no mention of fever anywhere.
The hemoglobin at this time 4/11/13 is near normal. The creatinine is also not grossly elevated 1.7 mg%.
Now the second record 25/11/13 suggests severe AR which was mild just 20 days prior.
Where did the patient lose so much blood that she had to be given blood transfusion?
What caused the sudden renal failure in this patient who had creatinine of 1.7
Infective endocarditis can cause anemia and renal failure but again there is no mention of infective endocarditis in 25/11/2013 nor is there a mention of fever or antibiotics!
What is her latest Hemoglobin, creatinine at this point of time?
If she has Infective endocarditis, she probably will be very sick with low hemoglobin and high creatinine. In that case she needs antibiotic treatment for few days and early surgery if she deteriorates. It will be a high risk surgery given the infective endocarditis and renal failure.
But if the hemoglobin is ok, the creatinine is indeed still 1.7 and the patient doesnt have infective endocarditis and had severe AR with moderate LV systolic dysfunction with creatinine 1.7 and functional class 2 or 3 still the best treatment is surgery!!!

And the surgery is very well done in INDIA!! I agree that the risk of surgery is very high in this case because of LV dysfunction, renal function and age. The risk in such cases is extremely high. It is difficult to say percentages but can be as high as 30 to 50 percent risk of mortality. But again there is no medicine which can prolong her life. Only surgery can provide some benefit.

Most surgeons would be skeptical to take up such a case because of fear of mortality and hence they maybe saying that such surgeries are not done in India. But you need to tell the surgeon that if the creatinine isnt too high then you are willing to take the risk of the surgery and go ahead with the procedure whatever the outcome maybe. Because if you dont take this risk then the outcome is going to be invariably bad.

I wish to know the current creatinine to assess if she indeed has renal failure. At creatinine of 1.7 I wouldnt label her as renal failure. Also I would like to know what led to the sudden fall in hemoglobin that she needed to be transfused with blood. Did she have fever? Kindly provide these details so that I may advise you better?

Regards
Dr Vivek Mahajan
DM Cardiology Fellow (PGIMER)
MD Medicine (AIIMS)