[HSF] tricuspid noncoaptation

Fri Feb 15 09:32:27 EST 2008

Dear Z
I'm in total agreement with what you said ...
thank you for the explanation

Yours

NFA

On Fri, Feb 15, 2008 at 6:12 AM, <zzhoumd at pol.net> wrote:

>
> Dear Nasser,
>
> Sorry I did not make it clear. I was waiting for Hal's patient information
> then we can have a good discussion.
>
> The simple answer is to make sure that TR is not the result of a failing
> RV, rather the cause of the failure. Usually the PA pressure is
> underestimated with severe TR. You will see significant rise in the PA
> pressure once TR is eliminated.
>
> When surgery is planned, need to prepare for valve replacement if
> annuplasty fails. If the RV is very large, valve tethering make a successful
> repair very difficult. Then comes the question of pacemaker wire. Are you
> going to be happy with epicardial leads, etc.
>
> Post op course is also difficult as a lot of fluids coming back to the
> circulation.
>
> Z Zhou
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Nasser F. Abou'Seada" <nfaabouseada at gmail.com>
>
>  Date: Thu, 14 Feb 2008 23:00:25
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] tricuspid noncoaptation
>
>
> 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. > >> (
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