[HSF] Re: Repairs, Rings, Dacron and hemolysis

[Tea Acuff]

Thanks for the support, Bob. 
I did not say that i don't use an annuloplasty, however.
But as always your "observations" make one pause to reflect in the veracity of ones own thoughts about ones own observations.
 tea


----- Original Message ----
From: "Rwmfglycar at aol.com" <Rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thursday, July 12, 2007 10:36:34 PM
Subject: [HSF] Re: Repairs, Rings, Dacron and hemolysis


Dear All,
Comments
1) There are repairs that can reasonably be done without an annuloplasty.  
e.g. a patient ruptures a chorda, goes into pulmonary edema but quickly  
stabilises Has significant regurg but excellent systolic function. An  enlightened 
cardiologist wants the patient restored to normal and refers him  immediately. 
The pathology is not Barlow's. Chordal replacement restores 10 mm  of central 
coaptation with zero leak. He does not need a ring. (Because "it is  written" a 
decision not to place a ring in a case like this requires the  capacity and 
the boldness to think for oneself).
2) Prasanna is right: it is the jet against the cloth that breaks up the  red 
cells. It doesn't happen if a mural annulus shortening suture or pericardium  
are used. The experience of hemolysis ceasing after some time, presumably  
because of eventual covering of the cloth by host tissue must be quite rare. I  
only used one Carpentier ring and a couple of Duran rings in my whole career 
so  the only cases I saw were done at St Elsewhere Medical Center. These were 
all  severe hemolysis and had all been followed for some time. Where the jet 
was  striking the cloth it was invariably bare, while the rest of the ring 
already  had a host fibrous covering; the jet had prevented host ingrowth and been  
associated with red cell destruction. The same is seen at the site of  a 
perivalvar leak. 
3) The Mayo Clinic described another cause of hemolysis not involving jets  
striking cloth; two jets striking each other. They called it "colliding jets".  
(Hal, perhaps an interscallop leak meeting a central jet?).
Bob



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