[HSF] redo double valve
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Mon Oct 16 05:34:31 EDT 2006
Incidentally ...... EXCISION of a pannus is certainly inviting for the
re-growth of a new one !!!!!! ..........
NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Sunday, October 15, 2006 10:38 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] redo double valve
>
> 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