AW: [HSF] aortic root reimplantation and Rv dysfx

[Hgrmd at aol.com]

Dave,
  Until your post, I missed the fact that Erdinc didn't reimplant the  RCA 
orifice.  Without having seen the films, I will bet you that small RV  branches 
were knocked off, and that was one of the contributing factors to the  RV 
being dead.  Years ago, I remember doing an AVR in a lady with a tiny  root.  I 
had to shoe horn in a small mechanical valve.  The RCA was  nondominant, and I 
remember that the orifice was obstructed.  I reasoned  that since the RCA was 
nondominant, the patient could bet by with the orifice  obstructed.  The 
patient came off pump and went to CVICU looking pretty  good.  However, over the 
next few hours her systemic pressure dropped,  along with the cardiac output.  
The next morning, TEE revealed a well  contracting LV and mechanical valve.  
Unfortunately, the RV was  akinetic.  She died.  That's a lesson I've never 
forgotten.   Thanks for reminding me.
 
Hal



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