AW: [HSF] aortic enlargement-Controlled after Kirklin´s book

Sat Feb 16 12:25:23 EST 2008

Bob,Prasanna,
You are right, I controlled the techniques now with Kirklin-Barratt
Boyes--Kouchoukos last edition 2003. Those incorrect illustrations come from
a Children Cardiac Surgery book, may be sold all over the world, should we
burn all them?. Very difficult.

The original german paper from Rastan (taken from Kirklin´s): Rastan H,
Koncz J. Plastische Erweiterung der linken Ausflussbahn: eine neue
Operationsmethode. Thorax Chir 1975;23:169
Then Rastan H, Abu-Aishah N, Rastan D,Heisig B, Koncz J, Jornstad PG.
Results of aortoventriculoplasty in 21 consecutive patients with left
ventricular outflowtract obstruction. J Thorac Cardiovasc Surg 1978;75:659
The paper from Konno and Imai in J Thorac Cardiovasc Surg was from
1975;70:909, logically, the first in English Language.
I will ask on Monday a copy of the originals in the library.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
rwmfglycar at aol.com
Gesendet: Freitag, 15. Februar 2008 16:36
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] aortic enlargement

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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> --
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-- 
Prasanna Simha M
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