[HSF] tricuspid noncoaptation

Thu Feb 14 21:03:01 EST 2008

"a little better if you have done some."

Dear Z
Certainly one thing I have learnt during my thoracic training in Liverpool
& Blackpool, that thoracotomy is far away from being non-painful .. even
with a muscle sparing incision- ... yet to my mind, the issue is not just
the pain ... nor the SCAR ..... -whereas we already do have an old incision-
but in the MUSCLE CUTTING involved in thoracotomy ...... please correct me
if I am wrong ..... such a right thoracotomy would certainly entail muscle
cutting ... the RA will be in the DEPTH of the wound .... plus the known
difficulties in securing the aorta and the cavae .....
I am not saying it is a wrong incision ........ might even be better in case
of a primary incision ... in the hands of those acquainred with it
..........
yet
the issue is WHY should there be another incision where we do already have
one ???? any special reason ? ,,....
certainly a rib fracturing incision is NOT less painful than a sternotomy
...
 and for those who have seen patients coming to postoperative clinics after
thoracotomy incisions ..... -especially in a total thoracic practice I mean-
. they would understand the feelings and the defects of patients having a
CUT muscle, a weak limb .... a new scar ..... for no cosmetic reason !!!!
apart from that ....... the issue elegantly raised by ANI ........ what IF
the patient should require another intervention for another procedure on the
mitral later on ???? ........... would not the designated surgeon  -then-
have wished the right thoracotomy approach is virgin ???  ........
sure we are ALL aware of the lung adhesion problems after thoracotomy
........ !! ...

all the time I do feel grateful to my magnificent teachers .... J.D.
Drakeley, R.D.Donnelly, J.L.Mercer ..... R.K Khan, and R.G. Gandhi .... real
masters of thoracic surgery .... high volume load .... wide real practice
... and extra-ordinary professionals ...

NFA
On Thu, Feb 14, 2008 at 7:43 AM, Zhandong Zhou <zzhoumd at pol.net> wrote:

>
> The recovery from thoracotomy is a little better if you have done some.
>
>
> ----- Original Message -----
> From: "Nasser F. Abou'Seada" <nfaabouseada at gmail.com>
> To: <OpenHeart-L at lists.hsforum.com>
>  Sent: Thursday, February 14, 2008 8:58 AM
> Subject: Re: [HSF] tricuspid noncoaptation
>
>
> > 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)> >
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