[HSF] Trip to Croatia

[Hgrmd at aol.com]

Prasanna,
  I can certainly empathize with the difficulty in accessing the  mitral 
valve if the heart is rotated towards the right.  I encountered that  earlier this 
week when I did a triple valve, maze on a patient with previous  CABG and a 
patent LIMA.  I didn't want to take the time, trouble , or risk  to control the 
LIMA pedicle.  In not doing as such, the left side of the  heart was fixed by 
adhesions while the right side dropped down as it was freed  up.  While doing 
the mitral repair, I could see, but it was a bit of a  struggle.  
  The reasons you gave to preserve the Starr-Edwards certainly make  sense, 
particularly in the mitral position.  I doubt you would have done  that if the 
valve had been in the aortic position.  About 4 months ago, I  had a 58 yo man 
with a 10 cm ascending aorta who had a 10 year old aortic  Starr-Edwards.  In 
1987, it had been implanted by a surgeon in Lima, Ohio  for bicuspid aortic 
stenosis.  I found it incredible that even in 1987, an  American surgeon would 
put in an aortic Starr-Edwards.  I fixed him with an  ATS composite graft, and 
he did well.
Hal



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