[HSF] Bicuspid aortic valve and dilated ascending aorta

[Nasser F. Abou'Seada]

Dr. Zhou
surely the right 2nd ICS incision is more cosmetically preferred. Sure,
avoiding median sternotomy especially an upper L- shaped incision is a great
advantage. all you cut through is soft tissues?... that reminds me with the
very similar approach of Chamberlain's incision anterior mediastinotomy.

I wonder whether you have a preset criteria as to when to use such approach,
and in which cases. we 'd be very interested in your experience in that
technique.

Kindest Regrads

NFA


On 4/24/07, Zhandong Zhou <zzhoumd at pol.net> wrote:
>
>
> The main advantage of this incision is to avoid sternotomy. Patient have
> no restriction after 2 weeks. My patient went to hunting 3 weeks after
> surgery and he can use gun without worried about recoiling. I used to use
> midline incision with L to the right. It bleeds a lot more than thoracotomy
> either from the right IMA or bone marrow. However, the exposure is a little
> better with mini sternotomy. For AR, the surgery is not difficult at all.
>
> Z Zhou
>
> ----- Original Message -----
> From: "Ani Anyanwu" <anianyanwu at hotmail.com>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Tuesday, April 24, 2007 6:12 AM
> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
>
> Dr Zhou
>
> I am curious to know why patients would prefer this to a (mini) midline
> incision - scars seem to be of similar length and in a similar place except
> one is transverse and other is longitudinal.
>
> For a woman presumably it is on superior aspect of mammary gland? I can
> understand the cosmetic attraction of submammary inscisions but what is the
> advantage (and evidence if available) for this approach?
>
> Thanks
>
> A Anyanwu
> ----- Original Message -----
> From: Zhandong Zhou<mailto:zzhoumd at pol.net>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> Sent: Monday, April 23, 2007 11:29 PM
> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
>
> Dear Hal,
>
> I agree with you that mini AVR first then follow him with yearly CT.
>
> I used to do AVR through mini sternotomy. I recently started using mini
> thoracotomy by entering 2nd ICS with femoral cannulation. I attach a
> picture
> to show the incision. It is more difficult to do it. However, patients
> like
> it.
>
> Z Zhou
>
>
>
> ----- Original Message -----
> From: <Hgrmd at aol.com<mailto:Hgrmd at aol.com>>
> To: <OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>>
> Sent: Monday, April 23, 2007 9:14 PM
> Subject: Re: [HSF] Bicuspid aortic valve and dilated ascending aorta
>
>
> > Dear Dr. Zhou,
> >  I've never done an AVR through a 2nd ICS mini thoracotomy.  I  always
> use
> > the "L" from the sternal notch to the right 4th ICS.  It's not  as nice
> > cosmetically, but you can easily go to a full sternotomy
> should  technical
> > difficulties arise.  This approach is especially nice for  redos.
> >  As for the 4 cm aorta, I don't think that meets criteria in a non
> > Marfan's
> > patient.  I thought the cut off was 4.5 cm.  Tom Martin, what  do you
> > think?
> > Hal
>
> --
> Nasser  F.  Abou'Seada,
> MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
> FICS,FISCVS,FSSRCTS,FHMS,MESC