[HSF] marfan

[Ani Anyanwu]

I suppose it is all down to experience of the team in dealing with this problem. In our center, with the most experienced surgeons operating, a Barlow mitral valve repair and tricuspid repair would take up to 2 hours of clamp, often more, and a Yacoub or David would take about 2 to 3 hours of clamp. Also because of institutional bias, this patient would have deep hypothermic circulatory arrest and open anastomosis to allow resection of as much marfanoid aorta. In our hands therefore it would be a very long operation. We have combined a Barlow repair with a redo bentall following a prior homograft and that patient was on bypass for 5 hours. We are obviously slower surgeons so have to modify our practice accordingly. I think the important thing is to know what one's team is capable of delivering. If one is capable of delivering a high quality Barlow repair and high quality valve sparing root at one operation with three hours of clamp, then that is surely the way to go.
 
Ani



> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] marfan> Date: Sun, 23 Sep 2007 23:56:59 -0400> From: tdmartin2000 at aol.com> CC: > > In my opinion, and how do I say this correctly without offense, staging, although an option, would not be something that anyone that operates on this type of patient that I know of would offer. Your clamp time should be 3 hrs or less and with good cardioplegia it will not be a problem.> > Tom Martin> U of Florida> Gainesville> > > -----Original Message-----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Sat, 22 Sep 2007 8:46 am> Subject: RE: [HSF] marfan> > > > > think depends on the certainity with which you can repair his valve. He likely > as Barlow-type bileaflet prolapse. If you cannot guarantee near 100% that you > an repair the valve then I think best not to operate and wait till absolute > ndications for surgery for either the mitral valve, aorta or aortic valve.> > n our centre, we would likely offer him a mitral valve repair. The aortic > imensions you describe, together with the absence of aortic incompetence, do > ot seem plausible - I would wait to validate the measurements by CT. If indeed > ny of the measures are more than 4cm we would offer aortic root surgery. Doing > David and a complex Barlow repair as a single procedure can be a very long > schemic time: in a borderline ventricle like yours our approach would be to > tage the operations. So far we have always done a David or Yacoub first and the > itral shortly after or several months after (we did once such Marfan early this > onth who is now planning for the mitral valve repair).> > ni> From: gbaslaim at hotmail.com> To: openheart-l at lists.hsforum.com> Date: Sat, 22 > ep 2007 12:49:17 +0300> Subject: [HSF] marfan> > > What would you advise as an > perative plan for a 19 yr male (78 kg, 191 cm), NYHA II, Marfan, pectus, and > ecreased LV from normal to 45-50% over the last one year. His echo showed > ncreased MR from trivial to mod-severe. normal trileaflet aortic valve. His > iameters (mm) aortic annulus= 26, sinus= 42, STJ= 33, asc aorta= 27? > CT chest > ending for pectus. No family H/O of sudden death or disection.> > G. Baslaim> > eddah, KSA> _________________________________________________________________> > indows Live Spaces is here! It’s easy to create your own personal Web site.> > ttp://spaces.live.com/signup.aspx> _______________________________________________> > penHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > > o UNSUBSCRIBE, to CHANGE email address, or to view archives:> > ttp://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by > he OpenHeart-L are subject to the policies and > disclaimers posted at:> > ttp://www.hsforum.com/listdisclaim> -----------------------------------------> ________________________________________________________________> 00’s of Music vouchers to be won with MSN Music> ttps://www.musicmashup.co.uk_______________________________________________> penHeart-L mailing list> Send postings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/openheart-l> All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at:> ttp://www.hsforum.com/listdisclaim> ----------------------------------------> > > ________________________________________________________________________> Email and AIM finally together. You've gotta check out free AOL Mail! - http://mail.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> -----------------------------------------
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