[HSF] redo double valve

[Nasser F. Abou'Seada]

Dear Bob 
I do agree with your points 
Obviously the important variables of concern here are the ASSOCIATED
circumstances .... rather than the valve itself .... changing the affected
valve "the platform for the incidence of pannus formation" would rather
start all over again a new [set] of differently associated milieu /
circumstances .... 

NFA

> From: Rwmfglycar at aol.com
> For whatever reason I saw very few absolutely pure pannus cases. If the
> pannus is the consequence of poorly controlled AC with thrombus, fibrous
> organisation of thrombus, further thrombus etc. then it is obviously
better to  start
> all over again with an absolutely bare valve or even switch to  a
> bioprosthesis in some cases. Another problem is that patients who are
unreliable
> about AC
> are also those who are unreliable about follow up so one  never is quite
sure
> whether the choice one made had a good outcome or not.
> Bobhn