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

[Macbook]

Prasanna,

Firstly, I guess that this poor lady was addressed to redo surgery  
too late. Right ventricle was extremely dilated as weel as both  
atria. I did nothing for the AFib as the left atrium was so large  
that only an autotransplantation was maybe effective. I am now at  
home and I have non more clinical data about the patient. Tomorrow I  
will post the preop echo numbers.

Thanks

Giuseppe

Il giorno 20/gen/08, alle ore 15:05, Prasanna Simha M ha scritto:

> Two things, I do not think a 27 size valve is stenotic  in an average
> patient especially the one with your weight and height - there must  
> be some
> other problem.
> There is also no need to "excise" leaflets or more precisely  
> disrupe the
> annulopapillary contnuity . If you really need to do that then  
> there are
> alternatives like creating artificial neochordae and bivalving the  
> PML. I
> can say that I virtually do all cases with annulopappillary continuity
> preservation in all mitrals (and  have my fair share of calcified  
> mitrals
> with small LV's . In fact I may make an inflammatory comment that  
> it is
> unethical not to preserve annulopappillary continuity in modern day  
> mitral
> valve surgery since we can always construct neochordae (these can be
> successfully be done with Ticron too - not necessarily Goretex)
> I do not know the EOA for 27 Epic can anyone give me the data). The  
> patients
> BSA by Dubois formula is 1.659 m2.
> What was done for her Afib ?
> Prasanna
>
>
> 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
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