[HSF] Blaze of every shade of red ... Glass of Pinotage .. [OT]

[Nasser F. Abou'Seada]

enjoying seeing the ??? Whales ????

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Rwmfglycar at aol.com
> Sent: Sunday, November 05, 2006 12:46 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Ruptured Sinus of Valsalva
> 
> In a message dated 11/4/2006 9:05:07 P.M. Eastern Standard Time,
> prasannasimha at gmail.com writes:
> 
> Basically a good echo for delineation of the anatomy and a cath to rule
> out associated CAD at her age.
> I think it is better to use a Goretex  patch as you are dealing with a
> high trans patch gradient. The classical  method is to patch both ends by
> a bicameral approach.
> I usually  transfix the windsock with a series of inverting purse strings
> and then  place a patch of Goretex taking care not to injure the coronary
> ostium (if  in a sinus bearing a coronary).
> Why do you need a CT ? A cardio CT may just  make some additional
> colorful pictures
> Prasanna
> 
> Dear Prasanna,
> You obviously are sold on Goretex patches as Hal is on Hemashield and I am
> on pericardium as a repair material. Obviously I have nothing against
extruded
> polytetrafluorethylene but I would not choose to use it in patch  form
> preferentially because it withstood a pressure gradient across it  better
than
> pericardium. There is simply no evidence for that. I never saw  any
failure of a
> pericardial patch in the form of rupture or aneurysm in  any application.
I did
> discuss a report once on aneurysm in outflow tract  patches: all of these
were
> false aneurysms; in other words failure of the suture  technique. We do
what
> we do but we need to be aware of what proof there is for  our prejudices.
I
> would say to Hal that there is no evidence from your  experience that
Bioglue
> actually is the reason for success in your last  three cases as compared
with a
> failure ten years ago. Maybe you know your way  around the ventricle
better
> than you did 10 years ago; maybe you and your  cardiologist and
> anesthesiologist  and Perrfusionist handled every aspect  of the recent
cases better. I
> would not be surprised if the margins of the  defect were better in this
decade
> and I am willing to bet that the patch margins  were far further from the
VSD
> than they were in your first case.
>  From where I write the sun has just gone down in a blaze of every  shade
of
> red over the Southern Indian ocean. I raise my glass of Pinotage in
> celebration of past and future successes whether or not we understand them
> completely!
> Bob
> 
> 
> 
> Hgrmd at aol.com wrote:
> > Dear Members of  HSF,
> >   I've just been referred a 70 yo lady with CHF who was  found by TEE
to
> have
> > a ruptured right sinus of Valsalva.   I was told that the root  wasn't
> dilated
> > and there was no  evidence of SBE.  Also, there were no  significant
> valvular
> >  abnormalities. I haven't seen her yet, but I understand she  has a
> classic
> > continuous murmur.  Over the phone, she was described  as  otherwise
> healthy.
> > Besides a cath and maybe a CT, what  else would be  helpful in the
workup?
> Also,
> > what type of  patch and how would you sew  it?  I'm thinking
gluteraldehyde
> 
> > cured autologous pericardium.
> > Hal
> >  _______________________________________________
> > OpenHeart-L mailing  list
> >
> > Send postings to:
> >   OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email  address, or to view archives:
> >  http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages  transmitted by the OpenHeart-L are subject to the policies
> and
> >  disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> >  -----------------------------------------
> >
> >
> >
> 
> _______________________________________________
> OpenHeart-L mailing  list
> 
> Send postings to:
> OpenHeart-L at lists.hsforum.com
> 
> To  UNSUBSCRIBE, to CHANGE email address, or to view  archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
> 
> All  messages transmitted by the OpenHeart-L are subject to the policies
and
> disclaimers posted  at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
> 
> 
> 
> _______________________________________________
> OpenHeart-L mailing list
> 
> Send postings to:
>  OpenHeart-L at lists.hsforum.com
> 
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
> 
> All messages transmitted by the OpenHeart-L are subject to the policies
and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------