[HSF] aortic enlargement

[Nasser F. Abou'Seada]

"The rewards of adding to our art and craft and yes, even science, are in
the long run internal. He must know that there are many many surgeons?who,
faced with the problem?turn to what he first thought of and described and do
good with it. That knowledge is the real reward."
Bob.

Very Well Said Sir

NFA
On Fri, Feb 15, 2008 at 9:36 AM, <rwmfglycar at aol.com> wrote:

> Thank you Prasanna,
> With apologies to Roberto, that illustration he sent needs to be destroyed
> (I was tempted to say burned but thought that too inflammatory a word) or,
> if not destroyed, put in an exhibition of the errors of eponyms.
> Incisions for enlargement of the narrow aortic root:
> 1) Sinotubular junction through middle of the noncoronary sinus to the
> lealfet sinusjunction. (This is as far as it can go).
> 2) Between the left coronary and non coronary sinuses down though the
> subaortic curtain to the intervalvar trigone but no further.
> 3) Through the base of the right coronary sinus through the
> interventricular septum and the right ventricular free wall?into right and
> left outflow tracts
> Possible shorthand names (why else do we use eponyms?):
> 1) Non coronary enlarging incision
> 2) Left coronary and Noncoronary separating incision
> 3) Right coronary and interventricular septal splitting incision
> All three enable patch enlargement of the aortic ?outflow tract. 1)
> enlarges the sinus dimension; 2) enlarges the aortic annulus; 3) enlarges
> the annulus and the left ventricular outflow tract
>
> Roberto, tell young Rastan that his father should not care that his name
> is not always mentioned. In the long run all that really counts is that he
> knows what he did. The rewards of adding to our art and craft and yes, even
> science, are in the long run internal. He must know that there are many many
> surgeons?who, faced with the problem?turn to what he first thought of and
> described and do good with it. That knowledge is the real reward.
> Bob.
> -----Original Message-----
> From: Prasanna Simha M <prasannasimha at gmail.com>
> To: OpenHeart-L at lists.hsforum.com
>  Sent: Fri, 15 Feb 2008 6:45 am
> Subject: Re: [HSF] aortic enlargement
>
>
>
> To reiterate from Edmunds CTS textbook
> Semantics but a Nick by definition should just go into the annulus and not
> beyond !!
> Quibbling it may be !!
> The anatomy of the aortic valve and its relationship to surrounding
> structures is important to successful replacement of the aortic valve,
> particularly when elargement of the aortic root is required. The
> Konno-Rastan aortoventriculoplasty involves opening and enlarging the
> anterior portion of the sub-aortic region. [4 ] , [5 ] The incisions for
> this procedure begin with an anterior longitudinal aortotomy that extends
> through the commissure between the right and left coronary leaflets.
> Anteriorly, the incision is extended across the base of the infundibulum.
> The differential level of attachment of the aortic and pulmonary valve
> leaflets permits this incision without damage to the pulmonary valve (Fig.
> 2-31) . Posteriorly, the incision extends through the most medial portion
> of
> the supraventricular crest into the left ventricular outflow tract. By
> closing the resulting ventricular septal defect with a patch, the aortic
> outflow tract is widened to allow implantation of a larger valvar
> prosthesis. A second patch is used to close the defect in the right
> ventricular outflow tract.
>
> Alternative methods to enlarge the aortic outflow tract involve incisions
> in
> the region of aortomitral continuity. In the Manouguian procedure (Fig.
> 2-19) , a curvilinear aortotomy is extended posteriorly *through the
> commissure between the left and non-coronary leaflets down to, and
> occasionally into, the aortic leaflet of the mitral valve*. [6 ] A patch
> is
> used to augment the incision posteriorly. When the posterior diverticulum
> of
> the outflow tract is fully developed, this incision can be made without
> entering other cardiac chambers, although not uncommonly the roof of the
> left atrium is opened. The Nicks procedure for enlargement of the aortic
> root involves an aortotomy that passes through the *middle of the
> non-coronary leaflet i*nto the fibrous sub-aortic curtain and may be
> extended into the aortic leaflet of the mitral valve. [7 ] This incision
> also may open the roof of the left atrium. When these techniques are used,
> any resultant defect in the left atrium must be closed carefully.
>
>
> On Fri, Feb 15, 2008 at 4:55 PM, Prasanna Simha M <prasannasimha at gmail.com
> >
> wrote:
>
> > yes the pictures actually make the Nicks and Monouguian nearly the same
> > !!
> > Prasanna
> >
> >
> > On Fri, Feb 15, 2008 at 4:07 PM, <rwmfglycar at aol.com> wrote:
> >
> > > Prasanna take a look at the pictures. From both your and my versions
> of
> > > Nicks v. Manougian they are I believe inaccurate. My plea for the
> avoidance
> > > of eponyms is reinforced.
> > > Bob
> > > -----Original Message-----
> > > From: prasannasimha <prasannasimha at gmail.com>
> > > To: OpenHeart-L at lists.hsforum.com
> > > Sent: Fri, 15 Feb 2008 3:19 am
> > > Subject: [HSF] aortic enlargement
> > >
> > >
> > > Roberto has snet a diagram of root enlargement procedures?
> > >
> > >
> > >
> > >
> > >
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> > --
> > Prasanna Simha M
>
>
>
>
> --
> Prasanna Simha M
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