[Fwd: Re: [HSF] intraop TEE-robotic radical reconstruction]

Tue Feb 26 15:02:40 EST 2008

Hal, 

You are right, the anterior leaflet for most part is 
destroyed, I endup replaced the valve and placed a few Gortex sutures to hold the

papillary muscle. I do not know if this will help, but I hope at least 
do no harm. 

I attached a picture taken from the scope.

Thanks for all the suggestions.

Zhandong

> On Tue, February 26, 2008 6:59 am 
EST, hgrmd at aol.com
wrote: 
> 
> 
> 
> Zhandong, 
> 
> ?
I suspect your valve is going to 
be very difficult or impossible to repair.?
Too 
> bad your cardiologist 
didn't follow the current guidelines and
refer the case to you 
> before 
symptoms or complications developed.?
I've got several referrals who do the 
> same thing.? They proudly tell me
how they are referring some case to me, 
because 
> the ventricle has
just started to dilate.? Hopefully, the word 
will finally get out 
>
to those guys. 
> 
> 
> 
> Hal 
> 
>

> -----Original Message----- 
> 
From: zzhoumd at pol.net 
> To: OpenHeart-L at lists.hsforum.com 
> Sent: 
Tue, 26 Feb 2008
6:36 am 
> Subject: Re: [HSF] intraop TEE-robotic radical 
reconstruction 
> 
> 
> 
> 
> 
>

Bob, 
> 
> this patient has known P2 prolapse in the past, but
the 
cardiologist has been 
> watching him as he was asymptomatic. 
> 
> Now the vegetation is mainly on the anterior leaflet. I may have
to remove 
the 
> entire anterior leaflet and part of the posterior
leaflet, then place 
some 
> Gortex chords. 
> 
>
Thanks for your suggestions. 

> 
> Zhandong Zhou 
>

> Sent via BlackBerry by 
AT&T 
> 
> -----Original
Message----- 
> 
From: 
rwmfglycar at aol.com 
> 
>
Date: Tue, 26 Feb 2008 03:56:28 
> 
To:OpenHeart-L at lists.hsforum.com

> Subject: Re: [HSF] intraop TEE-robotic 
radical reconstruction 
> 
> 
> ???? I did that from early 
on in the goretex
story. There is data , both 
> experimental and clinical 
to suggest
that an annular papillary connection 
> between the anterior half 
of
each papillary muscle and the annulus has better 
> preservation of 
ventricular function than?when only a posterior connection is 
> made. 
> Did this patient have chronic mitral insufficiency beforethe endocarditis?

Does 
> the patient have rheumatic disease? 
> ????? Having
decided 
that you will preserve anterior papillary? -? annular 
>
connection, the 
issue arises as to what tension the new chord should be under.

> The 
chordae are throughout systole and diastole under some tension.
Komeda 
> 
measured the diastolic tension as 10 G. If you are operating
with an arrested 
> heart this is, we guess, something akin to diastole. The
way to reproduce 
this 
> low pressure when inserting the new chord is
to pull the two arms of 
the suture 
> into a straight line and tie
them so that they stay in a 
straight line, not 
> tight and pulling
the pap muscle towards the annulus 
and not floppy and under 
> zero
tension. The former may interfere with 
diastolic function (see Komeda's 
> experimental?studies)?and the latter can 
have no effect. 
>
?????? I had one opportunity of a flollowup about 8 years 
ago. A patient of
mine 
> in whom I had had to do a complete excision of the 
anterior
leaflet some 7 years 
> earlier,?was murdered by her huaband. I 
went
down to the coroner's office to see 
> the autopsy. The chordae were 
beautifully covered by a thin layer of tissue. 
> However the anterior
half 
of the papillary muscles to which the?neochordae were 
> attached
?looked to 
me to be atrophic. I was not allowed to take samples because 
> it was a 
murder case. I took a photograph but cannot find it. I was not
sure 
> 
whether I had made the tension too loose or whether one pair
of chordae was not 
> enough stimulus to the papillary muscle to keep its
muscle at its original 
size. 
> The ventricular dimensions were
normal. 
> ???? 
> 
>From this you may deduce that there is
evidence that this is a good idea 
> 
but there is still much to learn.
Since it is easy ro do and takes very little 
> time I did it with the
assumption that it may be important. 
> Bob 

> 
> 
> 
> 
> F] intraop TEE-robotic 
radical reconstruction 
> 
> 
> 
> 
> 
Roberto and Hal, 
>

> I am going to operate on a patient tomorrow 
with SBE, it seems both
leaflets are 
> 
> involved. If both need to 
be resected, do
you place any Goretex suture from 
> papillary muscle to the 
annulus?

> 
> Z Zhou 
> 
> 
> Sent via 
BlackBerry by AT&T 
> 
> -----Original Message----- 
>

From: Hgrmd at aol.com 
> 
> Date: Mon, 25 Feb 2008 07:25:15 
> 
To:OpenHeart-L at lists.hsforum.com 
> Subject: Re: AW: [HSF]
intraop 
TEE-robotic radical reconstruction 
> 
> 
>
Roberto, 
> Of course, I've used Goretex chordae many times, anterior and
posterior, 
> since 1996. Over the last 3 years, I've fallen into Perrier's
"respect, 
not 
> resect" club for the posterior leaflet.
However, in the case 
that I cited, I 
> was particularly worried about
SAM in this Barlow's 
valve, since the 
> posterior leaflet was
abnormally tall. In addition, the 
distance from the 
> fibrotendinous
portion of the papillary muscles to the 
annulus wasn't very 
> long.
If I 
> had used new chords for the 
posterior leaflet, I suspect the
leaflet could 
> have been pulled all the 
way to the papilary muscle
without it being enough to 
> get rid of the 
prolapse. In cases of
SAM, I still think there is a place for 
> resection. 

> 
> Hal 
> 
> 
> 
> 
**************Ideas to
please picky eaters. Watch video on AOL Living. 
> 
(http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/

> 2050827?NCID=aolcmp00300000002598) 
> 
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