[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

Very well Said Sir

NFA

On Feb 13, 2008 4:06 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:

> Hal and Dave
>
> Why would we do a right thoracotomy here (other than because we can or to
> make life easier for ourselves)? Why should we give this lady another scar
> and how would it benefit her?
>
> A resternotomy here to repair the tricuspid is a low risk procedure and is
> not complicated (by low risk I refer to the resternotomy and NOT the
> tricuspid repair) . Using Hals technique of peripheral bypass, all one needs
> to do is go on bypass, the large empty RV/RA will fall back, spilt the
> sternum (or just the lower half), free the heart and then the large right
> atrium is most likely staring you in the face. Open it and fix the valve,
> close atrium then close sternum. The risks of resternotomy are minimal
> particularly if you use peripheral bypass and there is no need to dissect
> the heart and great vessels.
>
> I can understand a right thoracotomy if this was a primary operation, or
> if additional indication such as patent IMAs, multiple reoperations, aorta
> in proximity to sternum etc., but not sure there is justification to give
> this lady a second scar in this case. Also a thoracotomy is not an innocuous
> incision. Maybe too when in few years she comes for her mitral reoperation,
> you might wish you had left her right thorax virgin!
>
> Ani
>
>
>
> > To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] tricuspid
> noncoaptation> Date: Wed, 13 Feb 2008 16:06:45 -0500> From: hgrmd at aol.com>
> CC: > > 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 > > Awards. Go to AOL Music. > >> (
> http://music.aol.com/grammys?NCID=aolcmp00300000002565)> >
> _______________________________________________> > 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> >
> -----------------------------------------> > > > > Dr. David G. Harris, FCS,
> MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils River Private Hospital, >
> PO Box 1200, Kuils River, 7579, Cape Town, South Africa. > Tel
> +27-21-9006411 > Fax +27-21-9006412 Mobile +27-83-3309587>
> _______________________________________________> 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>
> -----------------------------------------> > >
> ________________________________________________________________________>
> More new features than ever. Check out the new AOL Mail ! -
> http://webmail.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>
> -----------------------------------------
> _________________________________________________________________
> Free games, great prizes - get gaming at Gamesbox.
>
> http://www.searchgamesbox.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
> -----------------------------------------
>