[HSF] tricuspid noncoaptation

[Nasser F. Abou'Seada]

Dear Z
I am not getting it ... please excuse my humble ignorance ..
you mean it should not be done ?
What is the projected Mortality Rate if not fixed ??
is the issue to do it or not to do it ?? or is it the approach to do it ??

NFA

On Thu, Feb 14, 2008 at 9:11 PM, Zhandong Zhou <zzhoumd at pol.net> wrote:

>
> Again, look at literature, redo tricuspid valve only is not a easy task.
> Mortality rate is not low.
>
> Z Zhou
>
> ----- Original Message -----
> From: "Ani Anyanwu" <anianyanwu at hotmail.com>
> To: <openheart-l at lists.hsforum.com>
> Sent: Wednesday, February 13, 2008 5:06 PM
> Subject: RE: [HSF] tricuspid noncoaptation
>
>
>  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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