[HSF] redo double valve
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Mon Oct 16 05:35:30 EDT 2006
I totally concur with Hal's debate ...
NFA
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of hgrmd at aol.com
> Sent: Monday, October 16, 2006 1:19 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] redo double valve
>
> Ani,
> Now that I think about it, I would agree with your concerns regarding
the treatment
> of the pannus. I've always treated it by replacing the valve. It's hard
to imagine that
> pannus removal could be as complete with the approach that James used.
I've never
> heard of any study comparing debridement versus re-replacement for
treatment of
> obstructive pannus formation. It'll be interesting to observe subsequent
echos in
> James's case.
> Hal
>
>
> -----Original Message-----
> From: anianyanwu at hotmail.com
> To: OpenHeart-L at lists.hsforum.com
> Sent: Sun, 15 Oct 2006 10:26 PM
> Subject: Re: [HSF] redo double valve
>
>
> 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.
>
>
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