[HSF] Valve repair in an irradiated chest

[Ani Anyanwu]

Performing a pericardiectomy in 48 yr old with no pericardial disease might be a bit of an overkill. This patient by virtue of his radiation, age and existing valve disease (regardless of repair or replacement) has a high probablity of needing future surgery. A pericardiectomy will make any future cardiac surgery extremely hazardous - indeed I would suggest the opposite to do minimal percardial dissectionb to prevent a likely dense inflammatory response that would complicate future surgery.
 
Ani



> Subject: RE: [HSF] Valve repair in an irradiated chest> Date: Sat, 8 Sep 2007 15:47:18 +0400> From: fazoury at ahdubai.com> To: OpenHeart-L at lists.hsforum.com> CC: > > Three years (?) seems to be a very short interval to develop radiation> induced valvular disease in the era of modern radiation therapy and I> will have to assume that there is no causative relationship.(Keep in> mind that Radiation injury is a continuous process that could be> responsible for higher long-term repair failure). > > Things to consider:> > 1- R thoracotomy approach as they might be increased incidence of> mediastinitis> 2- Look for signs of pericardial constriction pre-op and in any event> perform a pericardiectomy to avoid the late complication of const.per.> 3- Assume that there is always a degree of myocardial fibrosis and the> RV is usually the most affected so particular attention at RV protection> is needed> 4- Ensure that the ascending aorta is not calcified> 5- Look for ostial coronary stenosis on cath> 6- I would use prophylactic peri-op amiodarone as arrhythmia could be> poorly tolerated > > Hope this help. > > > Fouad M. Azoury, M.D.> Chairman Department of Cardiothoracic Surgery> > American Hospital Dubai> P.O.Box: 5566. Dubai> U.A.E> Switchboard: (971) 4 336 7777> Office: (971) 4 3096396> Fax: (971) 4 3096496> Website: www. ahdubai.com > > > -----Original Message-----> From: Mitch Lirtzman [mailto:drmitch at cox.net] > Sent: Friday, September 07, 2007 5:52 AM> To: OpenHeart-L at hsforum.com> Subject: [HSF] Valve repair in an irradiated chest> > Greetings all.> Next week, I've scheduled MVR/TVR in a 48yo man who was treated for > Hodgkin's three years ago. They managed to kill his kidneys with chemo> and > gave him "total body" irradiation. He now has severe MR and TR. Both> should > be amenable to repair. His coronaries are clean and EF~45%. The guy> looks > healthy as a horse but he can't walk more than 100 ft and can't lie> flat.> Any caveats, pearls, or pitfalls I should be looking for?> Thanks in advance.> Mitch> > > _______________________________________________> 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> -----------------------------------------
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