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

Sat Feb 16 17:36:11 EST 2008

Roberto,
Can I have a copy.Anyway it is surprising that when you quickly glance
at the image and see the Konno Rastan  and see an extension into the
mitral you assume that every diagram is OK (When it was obviously not
!!!).I was concentrating more on converting the diagram (to a suitable
JPEG rather than focussing on the contents assuming it was from a
textbook !! Obviously it was an error !!)
That was the diference between seeing (with eyes wide and mentally
shut) and "visualizing"
Luckily Dr Frater pointed it out so that I could go back and get a
better illustration and modify it to our requirements.
Prasanna
Thanks
Prasanna

On Feb 16, 2008 4:55 PM, Dr. Roberto Battellini
<battr at medizin.uni-leipzig.de> wrote:
> 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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> > --
> > Prasanna Simha M
>
>
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> --
> Prasanna Simha M
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-- 
Prasanna Simha M