[HSF] Valve Dysfunction - failure of Closure

[Nasser F. Abou'Seada]

Dear Don ...
- yes ... I do concur with all your thoughts ...

- yes ... the valve leaflets were open ... 

- there was no distortion of the annulus to my mind ... valve was not
oversized ..... a straight forward piece of cake case ... no problems intra-
or postoperative .. 

- and I quite agree with your marvelous question .... "> Why would the valve
jam while the heart was contracting and un-jam when the heart was virtually
dead?"
...????? .... manipulations during trials to cannulate ??? .... may be ???
don't know .... 
the point is that I have not seen the event except after it is too late
..... patient in OR ... soft Aorta ... pressure in 15s .... ... and can only
rely on what I have been told .. 

- Reluctance ??? .... for the same reason your paper was rejected from the
Lancet ..... except that "hidden industry representatives" here do control
so many strings .... !!! ... "things" are not as straight as they should be
..... unfortunately ... many matters are more likely to be used
"politically" within the departmental boards 
incriminating the surgical technique is an easy excuse to be made .... I
think it is already starting ... even on HSF ... 
However .... I do trust your IQ ... 


"> Death from bad valve are inexcusable but also preventable. We all
> have a duty to  be very suspicious of possible valve problems and to
> disseminate such information widely."
- to that I totally agree .... thank you for your backup ... 


NFA

> From: Donald Ross
> Nasser,
> This is a very serious event and as far as I gather there is no proof
> that the valve was jammed shut although the clinical presentation
> strongly suggests this.
> When you eventually got to the valve you said one leaflet was open
> and the other was not jammed.
>   Is that correct?
> It would seem to be impossible for a suture or strand of tissue to
> jam both leaflets and it should have been obvious if that was the cause.
> Another strange aspect of this case is the relatively late presentation.
> One would expect an operative mechanical problem like distortion of
> the ring to present early.
> Why would the valve jam while the heart was contracting and un-jam
> when the heart was virtually dead?
> 
> I don't understand your reluctance to tell us the valve type. "
> Sacred brand"  St Jude I expect but which type?
> 
> The reason I am so concerned is that I have been involved in three
> deaths from the  Shiley valve strut failure fiasco and I had a
> difficult time promulgating the danger involved in the use of this
> valve including in having a letter to the Lancet rejected; probably
> industry related.
> 
> The valve company is likely to give you false information about other
> similar incidents if they have occurred or blame you for bad surgical
> technique
> if my experience is anything to go on.
> 
> Hal, can you shed more light on the problem you had with St. Jude
> valves jamming?
> 
> Death from bad valve are inexcusable but also preventable. We all
> have a duty to  be very suspicious of possible valve problems and to
> disseminate such information widely.
> 
> Don
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