[HSF] Help re TGA with complex cor anatomy

[Nasser F. Abou'Seada]

is "Brave" the real word that you meant ?

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of Homayoun Jalali
> Sent: Friday, November 17, 2006 12:51 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Help re TGA with complex cor anatomy
> 
> Dear Dr Krishnan,
> 
> thank you for sharing your most interesting experience with us. It is
> good to hear about these successful surgeries. As you know well nearly
> no other surgical group will embark on a single stage arterial switch
> for a 6-8 month old baby with d-TGA intact ventricular septum. I am sure
> if you put together your results in this setting it will be accepted for
> presentation or publication in any major meeting or journal. Perhaps if
> others could have a closer look into your achievements and overall
> results they could make changes to their practices. I believe most of us
> are very reluctant to go beyond 8 or 12 weeks for a single stage switch
> in a true TGA intact septum and closed duct (even with LVAD and ECMO on
> board). What proportion of these older single stage switch did NOT pull
> through the surgery?
> 
> In regard with canulating a completely closed duct for the purpose of
> stenting it in a 6 to 8 month old baby I must say that your
> cardiologists are not only very good but also very brave. Any problems
> ever to reopen these ducts?
> 
> Homayoun Jalali
> 
> 
> >>> prasadkrishnan at vsnl.com 17/11/2006 12:18:12 pm >>>
> On the subject of regressed LV's in TGA, IVS I would like to share our
> experience from Apollo Hospital in Colombo, Sri Lanka. I trained at the
> All India Institute of Medical Sciences, Greenlane, Mayo and Cleveland
> Clinics. Dr. Roger Mee was my mentor for pediatric heart surgery.
> 
> We get many patients in this part of the world presenting late to the
> surgeon. We have performed arterial switches in over 12 patients with
> TGA, IVS and regressed LV's. Incidentaly we have performed a single
> stage switch with Coarct repair, in a 7 month old TGA, IVS with
> coarctation. Patient went home in 10 days and is doing very well 1 year
> later. Even the normal LV undergoes an adaptation by increasing LV mass
> to increase in pressure and volume load following birth. While this
> ability declines with age, it is still enough to pull out successful
> arterial switches upto age 6-8 months, in our experience. We have
> successfully stented open closed PDA's and trained some of these
> regressed LV's in 2-3 weeks. Our cardiologist has been able to probe and
> open PDA stumps to get a wire across and then stent the PDA open. This
> stent is removed at the time of the arterial switch by the surgeon.
> 
> I agree with the Bill Brawn being a great and one of the best surgeons
> in the UK.
> 
> Just wanted to convey regressed LV's in TGA and IVS are not as bad news
> as was previously thought. Great is God's creation the left ventricle.
> 
> Prasad Krishnan
> Cheif Cardiac Surgeon
> Apollo Hospital, Colombo
> 
> ----- Original Message -----
> From: ichfno at aol.com
> Date: Friday, November 17, 2006 6:38 am
> Subject: Re: [HSF] Help re TGA with complex cor anatomy
> To: OpenHeart-L at lists.hsforum.com
> 
> > Bill Brawn is considered by many in the UK to be the best
> > pediatric cardiac surgeon in the UK, however Marko Pozzi of
> > Liverpool has  had 1 death in the arterial switch operation in the
> > last 130 cases or so, and could be considered also. The issue is
> > that the child is no longer a candidate for a single stage ASO, so
> > will need a two-stage. I would suggest contacting Bill in
> > Birnmingham first and send him the data, also request his results
> > on 2-stage ASO's.
> >
> > William M Novick MD
> > Paul Nemir Professor
> > International Child Health
> > University of Tennessee Health Sciences Center
> > Founder/Medical Director
> > International Children's Heart Foundation
> > www.babyheart.org
> >
> >
> > -----Original Message-----
> > From: prasannasimha at gmail.com
> > To: OpenHeart-L at lists.hsforum.com
> > Sent: Fri, 17 Nov 2006 1:45 AM
> > Subject: Re: [HSF] Help re TGA with complex cor anatomy
> >
> >
> > Bill Brawn is a "Big Gun" in congenital heart surgery.
> > Virtually all coronary anatomies are now transferable albeit with
> > complex techniques.
> > Incidentally if it is a dTGA she has crossed the window for a
> > single stage arterial switch.
> >
> > Prasanna
> >
> > Rwmfglycar at aol.com wrote:
> > > Dear HSF pediatric surgeons,
> > > My nephew's friend, living in South Africa has a six month old
> > daughter who > was born with a complex Transposition of the great
> > arteries with difficult > coronary anatomy (I do not have the
> > particulars of this yet) and a coarctation. > The coarctation has
> > been done but the surgeon in Cape Town says the coronary > anatomy
> > makes it a very high risk case that she is reluctant to do. Ron >
> > Kinsley in Johannesburg, who has a large experience of
> > Transpositions is > allegedly also reluctant. They have been told
> > by their cardiologist that there is a > man called Brawn in
> > Birmingham, England, who tackles cases with difficult > anatomy.
> > > Are there cases of TGA with coronary anatomy that precludes
> > repair? Have you > heard of Brawn and is he known for doing
> > unusual cases? > Yours
> > > Bob
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