[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

Welcome Dave ...
who would pay for your private patients if the insurrence is not ?? ... what
would you do if the "pay" is NOT inclusive of the ring ???
what if the insurance is NOT paying cause the tricuspid is DEFINITELY not
incomptent at the time of the operation as indicated by TTE, TEE,
Epicardial ?? ... still the patient had a history of previous TR ??
indicating the "readiness" of the tricuspid annulus to dilate ? .. as in
this case ??

it is NOT a case of whichever technique is superior ... rather whichever
technique is FEASIBLE .... especially when no one is paying ....
Prasanna ... what about his indigenous mitral rings ???? ........... no one
is comparing Prasanna's "ingenious indigenous" rings to other rings ...
performance wise .... but rather ..COST & FEASIBILITY -wise ...

last point .. why a thoracotomy ?? giving the patient a new scar ??? ....
first time redo ... or even more is not a problem ... especially when the
heart need not be mobilized .... just the right side .... on beating heart
.... !!!!

nice to have heard of you ...

NFA

On Feb 13, 2008 1:58 PM, David Harris <drdharris at yahoo.co.uk> wrote:

> I agree with you Hal. In this case definitely a ring.
> Do you think a De Vega will suffice in cases of
> trivial TR (at the time of mitral repair)?
>
> Also, what about a mini-thoracotomy approach in this
> patient. This will be the simplest approach,
> especially as one does not need to access or clamp the
> aorta.
>
> Dave
>
> --- Hgrmd at aol.com wrote:
>
> > Erdinc,
> >   Your patient's plight supports my current policy
> > of doing tricuspid
> > valvuloplasty on around 70% of my mitral procedures.
> >  I totally agree with  Bob that
> > any documentation of moderate or worse TR on a preop
> > echo is a solid
> > indication for annuloplasty.  In addition, if the
> > systolic annular diameter  exceeds
> > 40 mm on the pre-CPB TEE, regardless of the degree
> > of TR, the patient  gets a
> > ring.  I always use the C-E MC3 ring.  It conforms
> > to the  natural 3D geometry
> > of the tricuspid annulus.  Better, more flexible,
> > rings  will be coming out
> > soon.
> >
> > Hal
> >
> >
> >
> > **************The year's hottest artists on the red
> > carpet at the Grammy
> > Awards. Go to AOL Music.
> >
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565)
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>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon
> Suite 207
> Kuils River Private Hospital,
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