[HSF] tricuspid noncoaptation

[erdinç naseri]

Dear Dr. Frater,
1.She didn't have history of TR before the first operation.
2.As a routine part of any intracardiac surgery I check TR by left index finger thru Ra appendix.Though a crude method it still gives some  idea about the amout and distance of TR jet.
3. Obviously we have missed something in the 1.st operation or there after.
erdinc> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] tricuspid noncoaptation> Date: Wed, 13 Feb 2008 04:20:04 -0500> From: rwmfglycar at aol.com> CC: > > Erdinc,> Did your patient have a history of tricuspid insufficiency before the first operation? Whatever the state of the tricuspid valve at surgery the history is a definite indication for annuloplasty. You clearly recognise that a dilated annulus would have been a surefire indication for an annuloplasty. Your case is a typical experience of cases in which the tricuspid valve is ignored. Only half the cases without annuloplasty have had a return to normal of the dilated annulus one year after surgery even when the pulmonary hypertension has resolved.> You should have success with annuloplasty. > Japanese surgeons have reported success with mechanical valves on the right. I used tissue valves myself. But so long as you have a succesful repair on the left it would be preferable to keep away from replacement on the right unless there is severe organic tricuspid disease.> Bob> > > > -----Original Message-----> From: Prasanna Simha M <prasannasimha at gmail.com>> To: OpenHeart-L at lists.hsforum.com> Sent: Tue, 12 Feb 2008 6:43 pm> Subject: Re: [HSF] tricuspid noncoaptation> > > > Incidentally in my case post op the TR was Grade 1 which became Trivial by> ay 4. Transthoracic Echo.> would not recommend a metallic prosthesis on the right side - seen people> o it and patients coming back early with thrombosis way too often.> f there was original coaptation leading then this must be due to annular> ilatation so I would think placing a ring (undersized) should bring about> oaptation. If the immediate TEE or Epicardial is bad then you could> onsider either leaflet extension as was suggested or a biporsthesis.> rasanna> On Feb 13, 2008 5:03 AM, 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.> _______________________________________________> 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> -----------------------------------------> > > -- > rasanna Simha M> ______________________________________________> penHeart-L mailing list> Send postings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to CHANGE email address, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/openheart-l> All messages transmitted by the OpenHeart-L are subject to the policies and > isclaimers posted at:> ttp://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> -----------------------------------------