[??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Miser

[Tea Acuff]

Not really to the point. I will publically admit that I do not always get a perfect repair. Good for you if you can, but I noticed a qualifier even for you. Surely there are valves (or other procedures) in which you push your own ability whatever that line may be. Would you add a step that may offer no benefit, but has potential complications? Forget the ring for the moment. I think it is patently obvious that the answer is we frquently do just that. I am not here to tell everyone how to repair valves. They are plently of surgeons delighted to do that. I just don't think we have to believe everything that they say or believe every conclusion that they draw. Although I do feel pretty beat up about standing up for a (very?) minority opinion. Luckily most of you can't figure out what I am saying most of the time. You might pass out!
 
Maybe that is why doctors hand writing is so bad, too.

tea


----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, July 12, 2007 8:28:23 PM
Subject: Re: [??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Miser


But is the solution not to try and perfect our repairs to eliminate the jet rather than avoid the use of rings?  

Indeed why blame the ring? It would be a fallacy to say such jets, narrow or otherwise, are only seen in ringed repairs.

I would say the lesson here is not to have patients leave the OR with mild MR, as was the case here. Mild MR as shown here will sometimes come back to haunt you. We would practically never accept mild MR after a repair for degenrative disease. If on saline testing there is a residual jet then the atrium would not be close until the cause of that jet is identified and rectified. If there is no jet on saline testing it would be most unusual to see mild MR on post-bypass TEE - if such is seen then there is something not right and we would go back on bypass an re-evaluate the repair.

Ani

----- Original Message -----
From: Tea Acuff
Sent: Thursday, July 12, 2007 7:50 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM,and other Misery

Exactly what led me a decade or so ago to largely abandon and certainly disprove the dictum to use rings for every repair.
tea


----- Original Message ----
From: Ajit Damle <damle at cableone.net>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, July 12, 2007 5:43:23 PM
Subject: RE: [??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM, and other Misery


I had one such a case. Post-repair that was a single narrow jet, seen only
in one view that was against a portion of Duran ring. Anemia stabilized at
8.5 gms. I ended up replacing the valve.

Ajit Damle

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of ??
Sent: Thursday, July 12, 2007 5:34 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [??????????????]Re: [HSF] Posterior Post-Infarction VSD, SAM,
and other Misery

Dear Members, I would like to have your thoughts about the following case

57 male had severe MR ( 4+) from mitral posterior leaflet prolapes, And
received mitral repair ( Q resection of the posteroir leaflet and 29# ring
( O shape ), TEE showed 1 one +  MR during surgery. He had uneventful
recovery and went home. Three weeks after surgery, he had jaundice and
hemolysis with elevated hepatic enzyme. HCT went down from 40 to 30%. Even
after 6 weeks medical treatment, his jaundice getting better and hepatic
enzyme went down too, but not normal yet. We checked echo again it shows
that the size of LA and LV is smaller that that before surgery, and have +
to ++ MR, with a II/6 systolic murmer. EF is normal. Now he is about 3
months after.  

Is his jaundice and hemolysis related to the ring or repair? Should we do
anything surgically? Replacememt of the mitral valve? or wait? or other?  

Many thanks in advance for your help.  

Steve  

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