[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

"1.Have I missed something in the 1.st operation?( I mean despite a nearly
normal tricuspid valve reported in TTE)"

TTE is no more good than your eyes. you have approached the MV through a SSI
.... you could have better judged the TV yourself much better than any TTE
or epicardial ....
the result of NILL Mitral regurge testifies to the excellent results of your
repair ....... I would have thought of doing a tricuspid annuloplasty anyway
in the first setting ... in accordance of Bob's recommendations .... may be
a DeVega procedure could have had a place here ....- HAL will not like that
!!- ... better than no ring and another operation.

"2.Shoul I try annuloplasty and which type or proceed directly with TVR?(
2.nd reop will be awfull)"

why would you consider replacement first place ??? ... especially with you
having a nice comptent mitral repair ? ....... IMHExperience of mechanical
prosthesis at TV.. Both patients died .... thrombosed on table, and
immediate postop ..... you should be able to get a nice anular repair ...
reoperation through a previous SSI is a piece of cake .... no cross clamp
.... beating heart ...

If I can not get a ring .... sure I'd prefer a DeVega in favour of A
mechanical prosthesis ....
De Vega still has got a place in our - at least mine- armamentarium ...

Best of luck ...
keep us informed

NFA






On Feb 12, 2008 5:33 PM, erdinç naseri <enaseri at hotmail.com.tr> wrote:

>
> Opinion requeted for the following case:
> 67Y/O female . Previously operated by me for severe MR.Mitral semirigid
> ring annuloplasty 1 year ago.Preop Echo:EF 25%,severe MR ,PAP moderately
> increased,minimal TR (no measurement of annular diameter),CAG:
> normal.Intraoperative assessment of mitral valve showed only annular
> dilatation with normal mitral valvular structure.Nothing is noted about
> tricuspid valve( trans-septal approach) Readmitted 2 weeks ago with severe
> ascites and 15 cm palpable liver. TTE showed nil mitral insufficiency ,
> severe TR with absolute noncoaptation of the leaflets.Both Rv and Ra
> dilated. tricuspid leaflets seem very defficient in tissue with restriction
> of motion.Tricuspid annular diameter 42 mm.
> 1.Have I missed something in the 1.st operation?( I mean despite a nearly
> normal tricuspid valve reported in TTE)
> 2.Shoul I try annuloplasty and which type or proceed directly with TVR?(
> 2.nd reop will be awfull)
> BTW,  since bioprostheses are about 40% reimbursed by social security
> institutions here ,how is the idea of implanting a metallic prosthesis in
> tricuspid position?
> erdinc
> PS: Prasanna had  a similar case sveral days ago.
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