[HSF] tricuspid noncoaptation
Nasser F. Abou'Seada
nfaabouseada at gmail.com
Fri Feb 15 09:37:21 EST 2008
A redo sternotomy should impose no bleeding nor collateral damage ...... IN
THE HANDS OF THEE WHO CAN PERFORM IT ...
NFA
On Fri, Feb 15, 2008 at 7:51 AM, <zzhoumd at pol.net> wrote:
>
> I think minimize the collateral damage and less of bleeding helps. No
> sternotomy also makes bleeding less and recovery easier.
>
> Z Zhou
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
>
> Date: Fri, 15 Feb 2008 22:14:17
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] tricuspid noncoaptation
>
>
> So, why is that different to a sternotomy apart from the length. With
> an OnQ they can be up in a few hours.
>
> >Dear NFA,
> >
> >Correct me if wrong, The thoracotomy you are talking about is the
> >traditional one that 10-15 inch long and cutting through all the
> >muscles. If you do a muscle sparing incision, the pain is
> >surprisingly less.
> >
> >the mini valve incision is only 2-3 inch size. The muscle is split
> >in the direction of the fibers. I admit sometimes they have
> >significant amount pain. But there are a few things can be done.
> >Such as use ON-Q, cut a small piece of the broken rib. Most
> >importantly, once pain goes away, usually after couple of weeks,
> >patients just look like a normal person. They have no restrictions.
> >Usually bleeding is not a problem. I have not had a post op bleeding
> >patient that require reexplore. I have done many robotic midcab
> >patients on plavix without stopping it.
> >
> >Hope that answers the questions.
> >
> >Z Zhou
> >
> >
> >
> >
> >Sent via BlackBerry by AT&T
> >
> >-----Original Message-----
> >From: "Nasser F. Abou'Seada" <nfaabouseada at gmail.com>
> >
> >Date: Thu, 14 Feb 2008 21:03:01
> >To:OpenHeart-L at lists.hsforum.com
> >Subject: Re: [HSF] tricuspid noncoaptation
> >
> >
> >"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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> >> >> -----------------------------------------> > > > > Dr. David G.
> Harris,
> >> FCS,
> >> >> MMED,> Cardiothoracic Surgeon > Suite 207 > Kuils River Private
> >> Hospital, >
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>
> --
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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