[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

"? I wouldn't risk a DeVega on any tricuspid repair, because I've seen
trivial TR become torrential in a very short time frame."
Exactly .... YOU would not ... as the operation is covered .... yet the
issue is in a milieu of deficient funding ... and it is the choice between a
mechanical !! ... or a simple technique ..... IN  A  SITUATION  OF
DEFICIENT  FUNDING ... !!

" If the annulus is dilated, it deserves a ring".
EXACTLY ...... IF dilated ..... what about the case discussed when the
annulus is NOT dilated -as the setting of first operation- but there is
evidence and history of previous TR symptoms ???? .........
would the situation be RING vs NOTHING ???
or better A SIMPLE technique in lieu of nothing ??

what I mean is that .... if there is a dilated annulus ... with sufficent
funding for the surgeon to work comfortably ..... sure a ring ... as you
have suggested .....
if the circumstances ...- as in many counteries where working with a limited
funding- dictate .... would you do a DeVega ?? or leave the tricuspid alone
??

Dear Hal ... how much is the MC3 ring ????

NFA




? Your suggestion to approach the tricuspid, beating heart, via the right
chest is exactly what I would do.


On Feb 13, 2008 3:06 PM, <hgrmd at aol.com> wrote:

> Dave,
> ? I wouldn't risk a DeVega on any tricuspid repair, because I've seen
> trivial TR become torrential in a very short time frame.? If the annulus is
> dilated, it deserves a ring.
> ? Your suggestion to approach the tricuspid, beating heart, via the right
> chest is exactly what I would do.
>
> Hal
>
>
> -----Original Message-----
> From: David Harris <drdharris at yahoo.co.uk>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 13 Feb 2008 2:58 pm
> Subject: Re: [HSF] tricuspid noncoaptation
>
>
>
>  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
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> >
> (http://music.aol.com/grammys?NCID=aolcmp00300000002565)
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>
> Dr. David G. Harris, FCS, MMED,
> Cardiothoracic Surgeon
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