AW: [HSF] Valve Dysfunction

[Nasser F. Abou'Seada]

Dear Axel 
	Thanks for your comments. Your presence indeed at the BHI Meeting in
Damascus was an enriching experience for all the participants. Also Dr.
Reber's questions were some sort of problematic as well .. !! .. I had to
face a "political crisis" cause of my answer to his question .... aha ....
good example ... may be that would show Hal that Truth is my shield too ....
!

I do quite agree with you and Alvarez, still I think that the sum of
knowledge and experience that have been exchanged between members with
different points of view, be it  regarding different valves' problems,
Decision making process, protocol initiation for such an un-usual emergency
cases, technical tips for the unwary, legitimate issues, .... all were worth
it.  Surely as Don have said ... I'm not to use this valve again. No doubt
the technical tips mentioned by Masters of the art have greatly enriched the
scientific milieu of the discussion. I'm really very thankful to Mark for
allowing this forum to come true. 

I feel very shameful for we must have given lovely Agnes a boring headache
during the BHI discussions .... may be I'd have the chance to receive you
all in Cairo. Though I can not promise a Dinner over an Aircraft Carrier
.... still ... there are a few little things that distinguish Cairo to be
seen around. Hal ... I promise ... you'll have a special Piano ready for
You. 


NFA

> From: prof.dr.axel laczkovics
> Nasser,
> (who would have thought that I do hear from you so soon after
> Damascus?)  I think a lot has been said already (as Alvarez`quoted
> nicely) and the discussion jumped from the  tragedy with a blocked
> valve over emergency EC to LV rupture with tissue valves.
> 
> I think we have to separate the problem and I want to comment only your
>   initial sad experience: as you have heard personally,  I have
> presented the 10yrs data on the ON-X valve and have never ever seen a
> blocked valve in aortic position,  which is impossible due to the
> ingenious design of that valve. You know that the leaflets are in what
> I call a tube and there is nothing like a hinge mechanism like the
> opening of a door, but the leaflet slide on a ramp up and down the
> housing and simultaneously clean it. I am not aware of anybody who had
> this sort of complication with an  ON-X valve.
> 
> Also the ingrowth of pannus (as discussed some weeks before) is
> impossible, at least not in aortic position.
> 
> So one should simply look at different valves at the same time and
> decide. Same is true for biological valves and the height and
> morphology of the struts; but I am not going in to details here. I do
> believe nearly all of the postings on this matter. Maybe we surgeons
> should rethink the position of the struts, when more colleagues have
> seen LV rupture at the 10 o'clock position?
> 
> I would also repeat John Fleges comment in never giving any  valve out
> of your hands; I do have negative experiences with 2 companies some 10
> years ago. One valve is not on the market anymore.  Let somebody
> inspect the valves in your presence and let also somebody else have a
> look to have several opinions and make up your mind. A cooperation with
> the Technical University in Cairo and its department for material
> testing would be great, if there are interested engineers?
> 
> Marhaba, Axel
> ( Laczkovics, Germany)