AW: [HSF] Lost leaflet-OT

Fri Oct 26 21:00:19 EDT 2007

If you remember from the CXRs that you so closely exam, the leaflets are only seen when viewed on end. Yes?
tea

----- Original Message ----
From: Prasanna Simha M <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, October 26, 2007 2:20:37 AM
Subject: Re: AW: [HSF] Lost leaflet-OT

The funny thing was that we could not image the blessed escaped leaflet in
the case which we encountered. (We screened the whole patient in the cath
lab).Probably I would have considered extracting it with a goose neck snare
to the femorals and extracting it from there rather than doing an aortotomy.
Prasanna

On 10/26/07, Dr. Roberto Battellini <battr at medizin.uni-leipzig.de> wrote:
>
> Legal reasons...
> You think it is better to wait fort he thrombosis?
> May be somebody could take it out interventionally?
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna
> Simha
> Gesendet: Donnerstag, 25. Oktober 2007 15:46
> An: OpenHeart-L at lists.hsforum.com
> Betreff: Re: AW: [HSF] Lost leaflet
>
>
> If it is non thrombogenic and removal entailed a larger procedure (for
> eg exposure of the aortic bifuraction) what would be the rationale of
> doing an unnecessary "anatomical" procedure rather than using a
> physiological procedure. (I am telling this because when we lost the
> leaflet we had a "great hunt" but could not find it and in the end gave
> up with no demonstrable ill effects. If we had gone chopping up his
> vascular tree there would have been a potential to do more harm than
> what we had already done (Since we do cardiac and vascular surgery in
> our institute - last week 2 aortobifemorals - one infra renal with local
> endarterectomy for a porcelain infrarenal aorta with 100 % occlusion)
> and the other suprarenal for a infra renal occlusion with an extremely
> hostile infrarenal aorta)!!
> Prasanna
>
> Dr. Roberto Battellini wrote:
> > I would have operated immediately, as a vascular surgeon.
> > Roberto
> >
> > -----Ursprüngliche Nachricht-----
> > Von: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
> > Rwmfglycar at aol.com
> > Gesendet: Mittwoch, 24. Oktober 2007 15:25
> > An: OpenHeart-L at lists.hsforum.com
> > Betreff: Re: [HSF] Lost leaflet
> >
> > All of you have missed  the question that was concerning me.
> > It was a standard St Jude Valve that had been in for 14 years. It was
> > operated on for perivalvar leak which, since the case was not one of
> > endocarditis
> > and the annulus not calcified (those being the likely causes  of late
> > paravalvar leaks), must have been there for years. The surgeon by   his
> own
> > admission
> > used heavy surgical clamps on the valve in the course of  taking it out
> and
> > lost
> > a leaflet. Ani's case illustrates this point very  well. The surgeon in
> > London grabbed a leaflet with an arterial clamp. There is  no pyrolitic
> > carbon
> > valve that can be grabbed with arterial clamps without  damage and no
> > leaflet that
> > can be grabbed without breaking some part of  it.
> > This should never happen. I have noticed that surgeons explanting a
> valve
>
> > treat it with great roughness with the idea that it is headed for the
> trash
> > can.
> >  This approach can damage the patient and destroy a precious specimen.
> > Anyone
> > in  the business of putting in valves should be in the business of
> studying
> >
> > valves, and this means sending  an intact specimen to the
> pathologist  and
> > the
> > company that manufactured the valve.
> > Excising a valve can be done without touching the leaflets whether
> tissue
> > or
> > carbon or anything else. Even the ring can  generally be no more than
> > mildly
> > damaged if the procedure is done properly. The time spent doing a proper
> > job
> > is not more than 15 minutes.
> > Noone has commented on what happened later.
> > You have in the postings seen examples of the fact that when a   leaflet
> from
> >
> > a bileaflet valve has been lost the consequence to  the patient has been
> > surprisingly benign in all the anecdotal cases that I have  heard of.
> The
> > explanation is likely to be that pyrolitic carbon is not   particularly
> > thrombogenic and
> > if edge on to the flow unlikely to cause  thrombotic obstruction.
> > What struck me was what happened postoperatively. A whole body or near
> > whole
> > body CT scan to see where it had ended up is reasonable.
> > Knowing that it was at the bifurcation who  would have done   nothing?
> > Who would have followed with Xrays or CT scans at intervals?
> > Who would have operated immediately to remove it?
> > Who would have tried to retrieve it from below using a catheter
> technique?
> > Who would have placed two stents and followed that with another
> CT  scan?
> > Sorry for not being clearer in my original posting
> > Bob
> >
> >
> >
> >
> > ************************************** See what's new at
> http://www.aol.com
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
> >
>
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>

-- 
Prasanna Simha M
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------