[HSF] Access to AV groove area post bypass Bioprosthesis choice

[Prasanna Simha M]

Somehow cardiologists tend to forget that the RV can fail due to TR just
like the LV can fail because of MR. In their assessment that needs to be
factored. We cannot just wish away the RV and procrastinate while insiduous
RV failure develops with lesser left heart disease but unfortunately they do
so.This may also be part of the problem
rasanna

On Jan 20, 2008 7:14 PM, Macbook <grescigno at mac.com> wrote:

> Dear Hal,
>
> I agree 100% with you. However I recently operated on a very sick 76
> year-old woman who had undergone a previous open heart mitral
> commissurotomy for mitral stenosis. She had 80 mmHg systolic PAP and
> a severe tricuspid regurg (of course), giant left and right atria and
> continuous AFib. I put a 27 Epic prosthesis (the european equivalent
> of Biocor) and a n° 30 MC3 tricuspid ring. BTW I had to resect both
> leaflet in order to obtain this valve size.  She needed NO to be
> weaned from mechanical ventilation; subsequently she was transferred
> to the ward but she continued to show some degree of right heart
> failure (I should admit that she was not managed in a perfect way and
> I did not follow the patient strictly and personally as was probably
> needed....) After 20 days she was retransferred to our ICU and
> reintubated for severe hypercapnia (100 mmHg!). All the subsequent
> attempts to wean were unsuccessful and the patient eventually died
> from pneumonia. A collegue of mine said that the Epic valve was the
> possible cause because of its small orifice area (the lady was 165 cm
> and 60 Kgms). Honestly I am not sure about his conclusion but I
> should say that next time I will put a mechanical SJM (she was
> already anticoagulated). I will appreciate your toughts and those of
> all the members about the orifice areas of Biocor/Epic prostheses and
> the possibility to create a patient/prosthesis mismatch in mitral
> position.
> Thank you
>
>
> Giuseppe
>
>
> Il giorno 20/gen/08, alle ore 13:14, Hgrmd at aol.com ha scritto:
>
> > Dear Yadav,
> >   It's nice to hear a new voice on HSF.  I understand your  concern
> > about
> > lifting the heart to inspect the CX graft in the presence of a  mitral
> > bioprosthesis.  Excellent suggestions have been given by Drs. Asai
> > and Flege.  In
> > addition, I would suggest that you use the smallest, lowest
> > profile bioprosthesis
> > available in order to lessen the likelihood of trauma to  the
> > lateral wall
> > from the struts of the valve.  That is why I've gone to  using the
> > St. Jude
> > Biocor.  The height of the Edwards porcine valve is  13mm, while
> > the Biocor is 9
> > mm.  This also reduces the likelihood of  important left
> > ventricular outflow
> > tract obstruction in small, hyperdynamic  hearts.  One valve I
> > would specifically
> > avoid is the Edwards  Perimount.  Years ago, I lost 2 patients from
> > LV wall
> > rupture while using  that valve.  The reason is its high profile as
> > well as
> > extremely sharp  struts.
> >
> > Hal
> >
> >
> >
> > **************Start the year off right.  Easy ways to stay in shape.
> > http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489
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-- 
Prasanna Simha M