[HSF] Traumatic tricuspid regurg

[Nasser F. Abou'Seada]

Congratulations Nand 
I concur with your decisions. You have done the best thing that you can do. 
BTW, have you looked at that "fibrotic" mass at distal end of SVC ???? ...
did you excise / remove it ??? ... if so, pls keep us posted as to the
histopathology .. 

I take it that the valve was huge enough as to accommodate a 34 ring "after"
placating the affected leaflet "Surgeon's right hand side tricuspid leaflet"
! ... resulting in bicuspidization of the valve with further annular
placation !!! .. 

Congratulations again for preserving the valve. 


NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of nand kejriwal
> Sent: Thursday, January 11, 2007 5:43 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Traumatic tricuspid regurg
> 
> Dear members
> 
> Update on my case. I operated upon the patient on Monday. Surprisingly,
TOE
> showed a mobile mass attached to distal SVC. I therefore cannulated
> innominate vein. The mass looked like a fibrotic lesion.
> 
> The ruptured pap muscle subtended the entire posterior (or inferior or
> lateral) leaflet and the adjacent portions of anterior and septal
leaflets.
> The other end of the muscle was attached to the anterior pap muscle as a
> separate head. I thought of reimplanting the pap muscle, but there was a
> rough area on the atrial surface of the posterior leaflet and the tip of
the
> torn muscle appeared unhealthy. So, I decided to excise a part of the
> posterior leaflet along with chordae and pap muscle, plicated the
remaining
> leaflet, narrowed the annulus with a pledgetted suture and inserted a 34
> annuloplasty ring. The valve was competent at the end of the procedure
with
> only trivial TR. The patient is progressing very well in the ward. All the
> cultures from the SVC mass and the tricuspid valve have been negative so
> far.
> 
> I thank the members for all the input. When I posted the case, I had more
or
> less made up my mind to replace the valve. But following advie from the
> members, I repaired the valve and it has worked well, at least so far.
> Nand
> 
> PS I was trying to send the pictures, but it did not go through. I have
sent
> it to Prasanna. Hopefully, he has received my mail and will be able to
post
> it.
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