[HSF] tricuspid noncoaptation

Fri Feb 15 09:19:47 EST 2008

Dear Z
yes ... you are right .... I am not discussing Robotics nor mini-access 2-3
inches incisions ............ yet do you think every one reading our thread
is thinking of mini-access incision ?? .... specifically ... would it be
understood for every surgeon non familiar with mini access -not all surgeons
on HSF are in USA- that you are speaking about a mini incision 2-3 inches ??
No Sir ...
I can not claim that .... no experience myself ........
I was spekaing of the traditional incision likely to be performed by every
surgeon who is NOT thinking in terms of mini-access surgery ...

how many surgeons - apart from USA- has got the facility to KNOW ... apart
from perform a mini-access surgery for the TV through the Rt Chest ??
Still ...
the issue remains ......
WHY  GIVING  THE PATIENT  A  NEW  SCAR ??????
cause we can do it ??

I am not doubting the abilities of masters of the art who can perform by all
means .... just illuminating a general rule of thumb for those young
surgeons who will take whatever is said as a fact ... non-negotiable ...

Thank you for your kind reply

Yours

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

> 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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