[HSF] redo double valve
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Mon Oct 16 05:33:26 EDT 2006
Well Prasanna ....
IMHO the reason for replacing the prosthesis resides in the very same reason
you have mentioned ..... "can be done many times" ...... !!!!! .... IMHO,
exposure to this "many times" should be avoided !!!!!
is it expected to remove a pannus from a "pannus-prone valve-situation"
every 3 years ????? .. why not sparing a future expected procedure ????
.......
incidentally .... if the valve has been there for 12 years ....... !!!!!
....... would not it be a sound decision to remove the "fatigued" valve and
insert a brand new one ....... for a fraction of the total costs of the
operation ???? .. not to mention sparing the patient another operative
procedure ???? ... in fact a bloody 3rd Re-replacement ????
Incidentally, a pannus is a reaction ASSOCIATED with [prefer it to "to"] a
foreign body .... not in all cases .... in some MINORITY of cases .. under
certain yet undefined unclear conditions ... therefore cannot even have an
anecdotal evidence-based-practice ...!!! ....... IMHO ... it is the unknown
unclear circumstances that count .... rather than the associated presence of
the Foreign body "valve prosthesis in such case".
NFA
> From: prasannasimha
> Ani,
> Pannus excision can be done many a time to save a prosthesis. It has
> been done multiple times and Dr Sampath Kumar of AIIMS Delhi has
> demonstrated it many a times very elegantly in various workshops. I have
> also done this at times with good results. Remember that a pannus is a
> reaction to a foreign body and you can get a Pannus again even if you
> change the valve. Its the foreign body that counts !!
> Last week on follow up, I have a Doctor who had undergone an AVR (Sorin)
> 12 years back. 3 years back he came with prosthetic obstruction and I
> only needed to do a Pannus excision. There was immediate relief of
> gradients that has been maintained over 3 years. I do agree that if the
> Pannus has invaded into the hinge points etc then pannus excision may
> not be possible without damaging the valve and then excision would be
> the rule.
> Prasanna
>
> Ani Anyanwu wrote:
> > Dear Dr Gammie
> >
> > Did you open the left atrium widely and insert the scope or did you put
the
> videoscope through a stab incision? Sounds rather slick and maybe
something we
> could do like in endocarditis cases and reops where we just need to
visually inspect
> the valve.
> >
> > BTW is there a chance this pannus could recur? One of my old bosses
once told me
> that the treatment for pannus round a mechanical valve was always to
change the
> prosthesis and if it is merely scraped away it would recur. I do not know
if his view
> was based on any evidence or just anecdote and would be keen to learn from
the
> experience of senior members in this regards.
> >
> > Ani Anyanwu
> >
> >
> > ----- Original Message -----
> > From: James S Gammie<mailto:gammie at comcast.net>
> > To:
OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> > Sent: Thursday, October 12, 2006 10:32 PM
> > Subject: Re: [HSF] redo double valve
> >
> >
> > Wanted to thank my friends on the HSF for sage advice on my patient
with
> > prior double mechanical valve replacements.
> >
> > Operated on her today: straightforward redo sternotomy; previous
surgeon
> > used a large patch (?dacron) on the aortotomy; it was
> > heavily calcified, so i excised it. You guys were on the money re
pannus:
> > there was a ring-like band of pannus just below the aortic valve;
> > removed old valved, completetely debrided annulus, and extended
aortotomy
> > down through annulus and beyond about 1 cm, stopping just
> > before roof of left atrium (is this a nicks or manouguian, i am not
sure..);
> > used a bullet-shaped dacron patch to reconstruct and was able
> > to insert a 21 HP St Jude valve. Before doing so got a good look at
the
> > mitral through the lvot: there was a ring of pannus here, as well;
> > was able to peel that off with a rongeur quite nicely; videoscope then
> > confirmed no obstruction of valve on either side.
> > Post op tee gradient across mitral down to 4, doing great in icu.
> > Thanks for help
> > jsg
> >
> >
> >
> >
> > Interested in the forum's opinion on this case:
> > >
> > > 24 yo female s/p AVR/MVR with mechanical valves at age 12 (12 years
ago)
> > > for rheumatic disease.
> > >
> > > Presents with progressive dyspnea, now with minimal exertion. Did
well
> > > after initial operation.
> > >
> > > Old operative note not available, cardiology letter states that a 19
St
> > > Jude valve placed in aortic position along
> > > with an "enlargement" procedure, and a 27 in mitral position. Early
> > > postop a gradient of 38 noted across aortic valve (not stated if
mean or
> > > peak). St jude medical has record of 19 HP insertion in aortic
position,
> > > no record of mitral.
> > >
> > > Patient is about 5 ft 6 inches 200 pounds, and was that size at age
12.
> > >
> > > Fluoroscopy shows all leaflets moving normally. Also confirmed on
TEE and
> > > MSCT. Normal ejection performance.
> > >
> > > Gradient across aortic valve = 100 peak, 55 mean. No subvalvular
> > > obstruction.
> > >
> > > Gradient across mitral valve (mean) = 12. Measurement of ID of
mitral
> > > valve on MSCT suggests it may actually be a size 25 valve.
> > >
> > > Would be delighted to have any advice from forum on managment. Am
> > > particularly puzzled with mitral gradient in the presence of
normally
> > > functioning reasonably sized valve.
> >
> >
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> > OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-
> l<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<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
> -----------------------------------------
More information about the OpenHeart-L
mailing list