[HSF] Traumatic tricuspid regurg

[Nasser F. Abou'Seada]

Thank you Bob ... for enriching us with your experience ... 

NFA

> From: Rwmfglycar at aol.com
> Dear Nand,
> Your cardiologist needs a severe telling off. Whether infected or not this
> patient needed urgent surgery from the time of diagnosis. All of this was
> established 30 or more years ago. There is no way the ruptured pap  muscle
> involves support of septal and "posterior" leaflets. The  septal leaflet
chordae
> arise directly from the septum. I put "posterior"  in quotes because I
contend
> that strictly speaking it is lateral. Be that  as it may, it is this
leaflet and
> perhaps adjacent scallops of which there may  be several, that have lost
> support of the flail pap muscle seen on the echo.  Reimplantation may be
an obvious
> option when you are in there. I never tried  this in this location and I
note
> that the lateral ventricular wall is likely to  be thin. I would use
several
> buttressed sutures(probably pericardium) passing  though to the outside
where
> I would use a single wide patch to buttress the  suture. However if you
are
> new to these games (I should add that we did  unpublished animal work on
> reimplanting pap muscles before we ever though  of doing it in a human), I
would not
> try this repair. You can instead eliminate  the unsupported leaflet (as
for a
> posterior mitral scallop flail ) and do  an annuloplasty. If you are
worried
> about the thin tricuspid tissue you can do a  McGoon infolding of the
flail
> tissue bringing your needle through two layers of  leaflet on each side.
The
> original Kay type tricuspid repair essentially  eliminated the part of the
> tricuspid valve that is flail in your  patient. There is no doubt (in my
opinion
> anyhow) that  you will serve your patient better with  repair rather  than
> replacement.
> I hope these thoughts are clear,
> Bob