[HSF] Trip to Croatia

[prasannasimha]

There was an elevated hemidiaphragm in addition too !!
In case of an aortic paravalvar dehiscence, I doubt it would be possible 
to save the valve as there just would not be enough place anyway to 
manipulate the needle between the aorta and the Aortic SE and  I would 
have exchanged the valve for something different. (I am not a great fan 
of the SE in aortic position).The aortic valve being superior most , the 
situation is different and I had the option of also doing an axillary or 
brachiocephalic cannulation and circ arrest with antegrade cerebral 
perfusion  or balloon occlusion with whole body perfusion (though when 
we did it for some case the blessed balloon kept slipping out of the 
opened aorta!!)
Prasanna
Hgrmd at aol.com wrote:
> 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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