[HSF] tricuspid noncoaptation

Fri Feb 15 09:30:17 EST 2008

"Unfortunately assessment of RV function seems to be the most difficult
thing
to do !!"
We agree Sir
NFA
On Fri, Feb 15, 2008 at 12:57 AM, Prasanna Simha M <prasannasimha at gmail.com>
wrote:

> Unfortunately assessment of RV function seems to be the most difficult
> thing
> to do !!
> Prasanna
>
> On Fri, Feb 15, 2008 at 12:02 PM, <zzhoumd at pol.net> wrote:
>
> >
> > The choice of the patients is the key.
> >
> >
> >
> > Sent via BlackBerry by AT&T
> >
> > -----Original Message-----
> > From: "Prasanna Simha M" <prasannasimha at gmail.com>
> >
> > Date: Fri, 15 Feb 2008 11:33:04
> > To:OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] tricuspid noncoaptation
> >
> >
> > The reason why redo tricuspid surgery has a high mortality is because of
> > RV
> > dysfunction not the procedure perse. You cant make shit shine with a
> > screwed
> > up RV. Therein lies the problem.
> > Prasanna
> >
> > On Fri, Feb 15, 2008 at 8:41 AM, 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
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> > > -----------------------------------------> > > > > Dr. David G.
> Harris,
> > FCS,
> > > MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils River Private
> > Hospital, >
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> > --
> > Prasanna Simha M
> > _______________________________________________
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>
> --
> Prasanna Simha M
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