[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

Hal
as I said .... better than nothing .... the situation here is not of LONG
TERM ... rather of to do something to the tricuspid ... or else not doing
anything cause of the funding .....
if someone is paying for the ring .... great ............ if no one is
paying for the ring ????? ........ I bit anyone can challenge a no-cost
method in lieu of doing NOTHING ..!!

the issue is NOT DeVega vs ring ..... but rather DeVega vs nothing .... when
there is NO other alternative ,....

after all ... again .. it is Ani's EBE Evidence Based Experience ..!!

Nice to hear from you again ..

NFA

On Feb 13, 2008 1:37 PM, <hgrmd at aol.com> wrote:

> Nasser,
>   DeVega's have a much higher recurrence rate than a ring.  Tyrone David's
> group presented this at the STS last year.  If he can't make a DeVega work
> well long term, I doubt anyone can.
>
> Hal
>
>
> -----Original Message-----
> From: Nasser F. Abou'Seada <nfaabouseada at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wed, 13 Feb 2008 2:07 pm
> Subject: Re: [HSF] tricuspid noncoaptation
>
>
>
> "1.Have I missed something in the 1.st operation?( I mean despite a nearly
> ormal 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
> r epicardial ....
> he result of NILL Mitral regurge testifies to the excellent results of
> your
> epair ....... I would have thought of doing a tricuspid annuloplasty
> anyway
> n the first setting ... in accordance of Bob's recommendations .... may be
>  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?(
> .nd reop will be awfull)"
> why would you consider replacement first place ??? ... especially with you
> aving a nice comptent mitral repair ? ....... IMHExperience of mechanical
> rosthesis at TV.. Both patients died .... thrombosed on table, and
> mmediate postop ..... you should be able to get a nice anular repair ...
> eoperation 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
> echanical prosthesis ....
> e Vega still has got a place in our - at least mine- armamentarium ...
> Best of luck ...
> eep us informed
> NFA
>
>
>
> n 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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