[HSF] Tricuspid repair w/pulmonary hypertension

[Ben Bidstrup]

>Ben,
>   I agree.  Bolling recently stated that he knows of no heart  that does
>better with severe TR.  That mistaken mindset is similar to the  one 
>stating that
>severe MR with poor LV function shouldn't be repaired for fear  of acutely
>increasing the afterload.  The real problem in those  cases is that 
>replacement,
>rather than repair, produces acute progression  in adverse remodeling
>(increased sphericity).
>Hal

The other thing that most people do not take into account is that 
volume overload is a major stress as well. The argument that the 
afterload is increased is fallacious - same as on the Right.  Reduce 
the volume overload, and the wall stress which is the afterload is 
reduced. If they do not come off bypass and have a lot of MR still, 
one needs to go back and fix it. But in many cases the horse has 
bolted.
That is possibly an oversimplfication as Bob no doubt will state.
-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon