AW: [HSF] aortic root reimplantation and Rv dysfx

[David Harris]

Good you mention these aortic valves with small roots.
Another problem we can have:when I was less
experienced I clearly remember shoe-horning a 19mm
mechanical into the small annulus of a small 19 year
old girl. The RCA osteum was rather close to the
sewing rim, but looked ok, maybe slightly distorted.

She came off the pump ok, but had multiple ventricular
extra-systolies, that should have alerted me at that
stage but this improved.

About 24 hrs after returning to the icu, she developed
sudden severe chest pain, and died from an RV infarct.
Since that day I been very meticulous about enlarging
the root, and sometimes take the patch along the RCA
annulus, and re-implant the RCA onto the patch if
necessary.
Dave Harris

--- Hgrmd at aol.com wrote:

> 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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Dr. David G. Harris, FCS, MMED,
Cardiothoracic Surgeon        
Suite 207                                
Kuils River Private Hospital,        
PO Box 1200, Kuils River, 7579, Cape Town, South Africa.            
Tel +27-21-9006411             
Fax +27-21-9006412      Mobile +27-83-3309587