From donross at bigpond.com Sat Mar 1 07:52:11 2008 From: donross at bigpond.com (Donald Ross) Date: Fri Feb 29 15:52:39 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <8CA48DF6CBCCEDC-C28-2D93@WEBMAIL-MC08.sysops.aol.com> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <8CA48DF6CBCCEDC-C28-2D93@WEBMAIL-MC08.sysops.aol.com> Message-ID: This question followed a heated discussion at one of our clinical meeting with one member doing a cryo maze if there was any history of AF while the other maintained, correctly I suspect, that there was no data supporting that strategy. Don On 29/02/2008, at 10:43 PM, hgrmd@aol.com wrote: > > Don, > > ? Absolutely.? In my opinion, patients going to the OR for an open > heart surgery should nearly always have their AF treated as well.? > My current policy is to use Atricure PVI for patients with PAF and > a procedure otherwise not requiring a left atriotomy.? If the > patient is in continuous AF, or if he requires an atriotomy anyway, > I do a full Cox-cryomaze with the ATS Cryocath.? The LA appendage > is oversewn from the inside.? I've abandoned stapling the LAA. > > Hal > > > -----Original Message----- > From: Donald Ross > To: OpenHeart-L@lists.hsforum.com > Sent: Thu, 28 Feb 2008 11:04 pm > Subject: Re: [HSF] Indications for maze with mitral surgery > > > > Dear Colleagues,? > Does a history of paroxysmal AF constitute an indication for > concomitant maze in mitral surgery?? > Don? > _______________________________________________? > OpenHeart-L mailing list? > ? > Send postings to:? > OpenHeart-L@lists.hsforum.com? > ? > To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > http://mmp.cjp.com/mailman/listinfo/openheart-l? > ? > All messages transmitted by the OpenHeart-L are subject to the > policies anddisclaimers posted at:? > http://www.hsforum.com/listdisclaim? > -----------------------------------------? > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From donross at bigpond.com Sat Mar 1 09:37:09 2008 From: donross at bigpond.com (Donald Ross) Date: Fri Feb 29 17:37:42 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <460661226-1204319856-cardhu_decombobulator_blackberry.rim.net-1690646362-@bxe035.bisx.prod.on.blackberry> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com><8CA48DF6CBCCEDC-C28-2D93@WEBMAIL-MC08.sysops.aol.com> <460661226-1204319856-cardhu_decombobulator_blackberry.rim.net-1690646362-@bxe035.bisx.prod.on.blackberry> Message-ID: <1ABFDD1E-61CA-4DAA-A6E6-B4741A24B987@bigpond.com> I guess the unknown is the incidence of AF after MV surgery in the group who only have a history of one or two episodes of AF prior to surgery rather than frequent episodes needing treatment where the indications for maze are undisputed. Don On 01/03/2008, at 8:17 AM, hgrmd@aol.com wrote: > Actually, Don, I just heard a lecture at Chitwood's program in > which the cost effectiveness and superior quality and quantity of > life with Cox-maze was presented. Just thinking logically, how > could the opposite be true, as long as an experienced surgeon was > doing it? > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > From: Donald Ross > > Date: Sat, 1 Mar 2008 07:52:11 > To:OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Indications for maze with mitral surgery > > > This question followed a heated discussion at one of our clinical > meeting with one member doing a cryo maze if there was any history of > AF while the other maintained, correctly I suspect, that there was no > data supporting that strategy. > Don > On 29/02/2008, at 10:43 PM, hgrmd@aol.com wrote: > >> >> Don, >> >> ? Absolutely.? In my opinion, patients going to the OR for an open >> heart surgery should nearly always have their AF treated as well.? >> My current policy is to use Atricure PVI for patients with PAF and >> a procedure otherwise not requiring a left atriotomy.? If the >> patient is in continuous AF, or if he requires an atriotomy anyway, >> I do a full Cox-cryomaze with the ATS Cryocath.? The LA appendage >> is oversewn from the inside.? I've abandoned stapling the LAA. >> >> Hal >> >> >> -----Original Message----- >> From: Donald Ross >> To: OpenHeart-L@lists.hsforum.com >> Sent: Thu, 28 Feb 2008 11:04 pm >> Subject: Re: [HSF] Indications for maze with mitral surgery >> >> >> >> Dear Colleagues,? >> Does a history of paroxysmal AF constitute an indication for >> concomitant maze in mitral surgery?? >> Don? >> _______________________________________________? >> OpenHeart-L mailing list? >> ? >> Send postings to:? >> OpenHeart-L@lists.hsforum.com? >> ? >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >> http://mmp.cjp.com/mailman/listinfo/openheart-l? >> ? >> All messages transmitted by the OpenHeart-L are subject to the >> policies anddisclaimers posted at:? >> http://www.hsforum.com/listdisclaim? >> -----------------------------------------? >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the >> policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the > policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From benjamin.bidstrup at bigpond.com Sat Mar 1 08:44:10 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Fri Feb 29 17:45:04 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> Message-ID: Prasanna, Am I correct in seeing / stating the valve was sewn in with 5 sutures? >30 year old male had AVR done 3 years ago by a colleague. At that time >Echo was normal. 3 months back patient started becoming breathless. No >fever and worsenedprogressively over a month and then came to us.. No >fever etc. Counts normal and Echo showed a major valve dehiscence and >a rocking valve.There was 1+ MR and severe TR. >It was decided to do an AVR +TV Plasty and the MR was acute and >thought to be due to annular dilatation. >Redo AVR done after TV ring placement (42 No). The approach was via >the adheren t RA over the aorta after incising the aorta and extending >it into the Torus aorticus of the Right Atrium.This allowed excellent >exposure and a 25 mm Chitra vavle was placed. Closure was done with >closure of the aortic torus and the aortic wall en mass and the RA was >closed thereafter there was a problem weaning so an epicardial showed >significant MR so an MVR was done. >Patient was weaned off but was not doing well despite increasing >supports with normal functioning valves and LV wall acceleration was 5 >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to >the ICU with maxi Inotropes after putting an IABPThe patient continued >to do poorly immediately on shifting and since his radial showed a >better curve than the femoral (actually he was receiving transaortic >NTG) so I started Pitressin with a dramatic change in events and >stoppage of all other inotropes in1/2 an hour and he continued to do >well. and the Pitressin was weaned off after a few hours. I rechecked >his drugs (He was in the medical ICU on Inotropes, raised liver >parameters (Childs A) , renal failure and had a Eurscore prediction of >58 %Mortality) and found that the cardiology residents had restarted >ACE Inhibitors that I had asked to discontinue 24 hours prior to >surgery. He was vasoplegic.and responded to Pitressin. He contined to >receive Intraortic NTG which did not cause problems after Pitressin >was started and weaned. >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of >reading and trials on imagin and Doppler interrogation of the Hepatic >artery - not as difficult as I thought !!) and there is a demonstrable >increase in hepatic artery flow velocity (both systolic and diastolic >) with Intraortic NTG and a decrease on stopping it and waiting for 5 >minutes). >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D. >I am not sure of the significance of one data set but it did seem >useful and reproducible in the patient (Improvement on restarting >NTG). On putting the IABP on you could clearly see diastolic >augmentation of hepatic arterial flow too !! >Currently off Inotropes , IABP removed (actually did not help much >anyway) and extubated. > >Prasanna > > >-- >Prasanna Simha M > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg" >X-Attachment-Id: f_fd8ro0tk0 >Content-Disposition: attachment; >filename="transtoric redoaortic valve eml.jpg" > >Attachment converted: Absolute Genius:transtoric >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD) >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From benjamin.bidstrup at bigpond.com Sat Mar 1 09:49:19 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Fri Feb 29 18:50:10 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <1ABFDD1E-61CA-4DAA-A6E6-B4741A24B987@bigpond.com> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com><8CA48DF6CBCCEDC-C28-2D93@WEBMAIL-MC08.sy sops.aol.com> <460661226-1204319856-cardhu_decombobulator_blackberry.rim.net-1690646362- @bxe035.bisx.prod.on.blackberry> <1ABFDD1E-61CA-4DAA-A6E6-B4741A24B987@bigpond.com> Message-ID: It will depend on the classification used. Here is one based on AHA, ACC and ESC; Classification The American Heart Association, American College of Cardiology, and the European Society of Cardiology have proposed the following classification system based on simplicity and clinical relevance.[4] * First detected atrial fibrillation: any patient newly diagnosed with atrial fibrillation fits in this category, as the exact onset and chronicity of the disease is often uncertain. * Recurrent atrial fibrillation: any patient with 2 or more identified episodes of atrial fibrillation is said to have recurrent atrial fibrillation. This is further classified into paroxysmal and persistent based on when the episode terminates without therapy. Atrial fibrillation is said to be paroxysmal when it terminates spontaneously within 7 days, most commonly within 24 hours. Persistent or chronic atrial fibrillation is AF established for more than seven days. Differentiation of paroxysmal from chronic or established AF is based on the history of recurrent episodes and the duration of the current episode of AF.[4][5][6] * Lone atrial fibrillation (LAF) is defined as atrial fibrillation in the absence of clinical or echocardiographic findings of cardiopulmonary disease.[4] Patients with LAF who are under 65 have the best prognosis. >I guess the unknown is the incidence of AF after MV surgery in the >group who only have a history of one or two episodes of AF prior to >surgery rather than frequent episodes needing treatment where the >indications for maze are undisputed. >Don >On 01/03/2008, at 8:17 AM, hgrmd@aol.com wrote: > >>Actually, Don, I just heard a lecture at Chitwood's program in >>which the cost effectiveness and superior quality and quantity of >>life with Cox-maze was presented. Just thinking logically, how >>could the opposite be true, as long as an experienced surgeon was >>doing it? >> >>Hal >>Sent from my Verizon Wireless BlackBerry >> >>-----Original Message----- >>From: Donald Ross >> >>Date: Sat, 1 Mar 2008 07:52:11 >>To:OpenHeart-L@lists.hsforum.com >>Subject: Re: [HSF] Indications for maze with mitral surgery >> >> >>This question followed a heated discussion at one of our clinical >>meeting with one member doing a cryo maze if there was any history of >>AF while the other maintained, correctly I suspect, that there was no >>data supporting that strategy. >>Don >>On 29/02/2008, at 10:43 PM, hgrmd@aol.com wrote: >> >>> >>>Don, >>> >>>? Absolutely.? In my opinion, patients going to the OR for an open >>>heart surgery should nearly always have their AF treated as well.? >>>My current policy is to use Atricure PVI for patients with PAF and >>>a procedure otherwise not requiring a left atriotomy.? If the >>>patient is in continuous AF, or if he requires an atriotomy anyway, >>>I do a full Cox-cryomaze with the ATS Cryocath.? The LA appendage >>>is oversewn from the inside.? I've abandoned stapling the LAA. >>> >>>Hal >>> >>> >>>-----Original Message----- >>>From: Donald Ross >>>To: OpenHeart-L@lists.hsforum.com >>>Sent: Thu, 28 Feb 2008 11:04 pm >>>Subject: Re: [HSF] Indications for maze with mitral surgery >>> >>> >>> >>>Dear Colleagues,? >>>Does a history of paroxysmal AF constitute an indication for >>>concomitant maze in mitral surgery?? >>>Don? >>>_______________________________________________? >>>OpenHeart-L mailing list? >>>? >>>Send postings to:? >>>OpenHeart-L@lists.hsforum.com? >>>? >>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:? >>>http://mmp.cjp.com/mailman/listinfo/openheart-l? >>>? >>>All messages transmitted by the OpenHeart-L are subject to the >>>policies anddisclaimers posted at:? >>>http://www.hsforum.com/listdisclaim? >>>-----------------------------------------? >>> >>>_______________________________________________ >>>OpenHeart-L mailing list >>> >>>Send postings to: >>> OpenHeart-L@lists.hsforum.com >>> >>>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>>http://mmp.cjp.com/mailman/listinfo/openheart-l >>> >>>All messages transmitted by the OpenHeart-L are subject to the >>>policies and >>>disclaimers posted at: >>>http://www.hsforum.com/listdisclaim >>>----------------------------------------- >> >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >> OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the policies and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >> OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the policies and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- > >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the >policies anddisclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From prasannasimha at gmail.com Sat Mar 1 05:57:20 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 29 19:27:50 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> Message-ID: <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> 5 Green and 5 white sutures so 10. Since youThe white are not seen well as they are enface. One can be seen well at the base of the strut. I have seen at least two reports showing no paravalavar rleaks post op. What could be the mechanism of such a destructive paravalavar leak in the absence of an overt history of endocarditis ? Prasanna On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup wrote: > > Prasanna, > Am I correct in seeing / stating the valve was sewn in with 5 sutures? > > > > >30 year old male had AVR done 3 years ago by a colleague. At that time > >Echo was normal. 3 months back patient started becoming breathless. No > >fever and worsenedprogressively over a month and then came to us.. No > >fever etc. Counts normal and Echo showed a major valve dehiscence and > >a rocking valve.There was 1+ MR and severe TR. > >It was decided to do an AVR +TV Plasty and the MR was acute and > >thought to be due to annular dilatation. > >Redo AVR done after TV ring placement (42 No). The approach was via > >the adheren t RA over the aorta after incising the aorta and extending > >it into the Torus aorticus of the Right Atrium.This allowed excellent > >exposure and a 25 mm Chitra vavle was placed. Closure was done with > >closure of the aortic torus and the aortic wall en mass and the RA was > >closed thereafter there was a problem weaning so an epicardial showed > >significant MR so an MVR was done. > >Patient was weaned off but was not doing well despite increasing > >supports with normal functioning valves and LV wall acceleration was 5 > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to > >the ICU with maxi Inotropes after putting an IABPThe patient continued > >to do poorly immediately on shifting and since his radial showed a > >better curve than the femoral (actually he was receiving transaortic > >NTG) so I started Pitressin with a dramatic change in events and > >stoppage of all other inotropes in1/2 an hour and he continued to do > >well. and the Pitressin was weaned off after a few hours. I rechecked > >his drugs (He was in the medical ICU on Inotropes, raised liver > >parameters (Childs A) , renal failure and had a Eurscore prediction of > >58 %Mortality) and found that the cardiology residents had restarted > >ACE Inhibitors that I had asked to discontinue 24 hours prior to > >surgery. He was vasoplegic.and responded to Pitressin. He contined to > >receive Intraortic NTG which did not cause problems after Pitressin > >was started and weaned. > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of > >reading and trials on imagin and Doppler interrogation of the Hepatic > >artery - not as difficult as I thought !!) and there is a demonstrable > >increase in hepatic artery flow velocity (both systolic and diastolic > >) with Intraortic NTG and a decrease on stopping it and waiting for 5 > >minutes). > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D. > >I am not sure of the significance of one data set but it did seem > >useful and reproducible in the patient (Improvement on restarting > >NTG). On putting the IABP on you could clearly see diastolic > >augmentation of hepatic arterial flow too !! > >Currently off Inotropes , IABP removed (actually did not help much > >anyway) and extubated. > > > >Prasanna > > > > > >-- > >Prasanna Simha M > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg" > >X-Attachment-Id: f_fd8ro0tk0 > >Content-Disposition: attachment; > >filename="transtoric redoaortic valve eml.jpg" > > > >Attachment converted: Absolute Genius:transtoric > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD) > >_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > > OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > > -- > Ben Bidstrup FRACS FRCSEd FEBCTS > Consultant Cardiothoracic Surgeon > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sat Mar 1 06:16:28 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Fri Feb 29 19:53:39 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <1ABFDD1E-61CA-4DAA-A6E6-B4741A24B987@bigpond.com> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <8CA48DF6CBCCEDC-C28-2D93@WEBMAIL-MC08.sysops.aol.com> <460661226-1204319856-cardhu_decombobulator_blackberry.rim.net-1690646362-@bxe035.bisx.prod.on.blackberry> <1ABFDD1E-61CA-4DAA-A6E6-B4741A24B987@bigpond.com> Message-ID: <89c4ed2d0802291646k533502d6h2679af0f4b0612c6@mail.gmail.com> The percentage of recurrence is around 60 % for paroxysmal Afib in the long run.I think there was an article to that effect but I cannot recollect it off hand. Prasanna On Sat, Mar 1, 2008 at 4:07 AM, Donald Ross wrote: > I guess the unknown is the incidence of AF after MV surgery in the > group who only have a history of one or two episodes of AF prior to > surgery rather than frequent episodes needing treatment where the > indications for maze are undisputed. > Don > > > On 01/03/2008, at 8:17 AM, hgrmd@aol.com wrote: > > > Actually, Don, I just heard a lecture at Chitwood's program in > > which the cost effectiveness and superior quality and quantity of > > life with Cox-maze was presented. Just thinking logically, how > > could the opposite be true, as long as an experienced surgeon was > > doing it? > > > > Hal > > Sent from my Verizon Wireless BlackBerry > > > > -----Original Message----- > > From: Donald Ross > > > > Date: Sat, 1 Mar 2008 07:52:11 > > To:OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Indications for maze with mitral surgery > > > > > > This question followed a heated discussion at one of our clinical > > meeting with one member doing a cryo maze if there was any history of > > AF while the other maintained, correctly I suspect, that there was no > > data supporting that strategy. > > Don > > On 29/02/2008, at 10:43 PM, hgrmd@aol.com wrote: > > > >> > >> Don, > >> > >> ? Absolutely.? In my opinion, patients going to the OR for an open > >> heart surgery should nearly always have their AF treated as well.? > >> My current policy is to use Atricure PVI for patients with PAF and > >> a procedure otherwise not requiring a left atriotomy.? If the > >> patient is in continuous AF, or if he requires an atriotomy anyway, > >> I do a full Cox-cryomaze with the ATS Cryocath.? The LA appendage > >> is oversewn from the inside.? I've abandoned stapling the LAA. > >> > >> Hal > >> > >> > >> -----Original Message----- > >> From: Donald Ross > >> To: OpenHeart-L@lists.hsforum.com > >> Sent: Thu, 28 Feb 2008 11:04 pm > >> Subject: Re: [HSF] Indications for maze with mitral surgery > >> > >> > >> > >> Dear Colleagues,? > >> Does a history of paroxysmal AF constitute an indication for > >> concomitant maze in mitral surgery?? > >> Don? > >> _______________________________________________? > >> OpenHeart-L mailing list? > >> ? > >> Send postings to:? > >> OpenHeart-L@lists.hsforum.com? > >> ? > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:? > >> http://mmp.cjp.com/mailman/listinfo/openheart-l? > >> ? > >> All messages transmitted by the OpenHeart-L are subject to the > >> policies anddisclaimers posted at:? > >> http://www.hsforum.com/listdisclaim? > >> -----------------------------------------? > >> > >> _______________________________________________ > >> OpenHeart-L mailing list > >> > >> Send postings to: > >> OpenHeart-L@lists.hsforum.com > >> > >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >> All messages transmitted by the OpenHeart-L are subject to the > >> policies and > >> disclaimers posted at: > >> http://www.hsforum.com/listdisclaim > >> ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From drmitch at cox.net Sat Mar 1 09:44:07 2008 From: drmitch at cox.net (Mitch Lirtzman) Date: Sat Mar 1 10:42:34 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <89c4ed2d0802290543k2a681f30h14345156899bad9@mail.gmail.com > References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <007e01c87ad5$35faa2e0$b3160a06@HZLPC0679> <89c4ed2d0802290543k2a681f30h14345156899bad9@mail.gmail.com> Message-ID: <6.2.1.2.2.20080301094223.04d76a58@pop.east.cox.net> Hal, When you indicate a " full Cox-maze", do you mean right and left-sided lesions, or just the left atrial set? Thanks. MitchAt 07:43 AM 2/29/2008, you wrote: >ps you can also wave the cautery around for no extra cost !! >Prasanna > >On Fri, Feb 29, 2008 at 6:45 PM, Dr. Roberto Battellini > wrote: > > Don, > > In Leipzig yes, we have the atria open and we have the Cryocath, and takes > > 15 minutes. > > Roberto > > > > -----Urspr?ngliche Nachricht----- > > Von: openheart-l-bounces@lists.hsforum.com > > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Donald Ross > > Gesendet: Freitag, 29. Februar 2008 05:05 > > An: OpenHeart-L@lists.hsforum.com > > Betreff: Re: [HSF] Indications for maze with mitral surgery > > > > > > > > Dear Colleagues, > > Does a history of paroxysmal AF constitute an indication for > > concomitant maze in mitral surgery? > > Don > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > >-- >Prasanna Simha M >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- From enaseri at hotmail.com.tr Sat Mar 1 17:16:02 2008 From: enaseri at hotmail.com.tr (=?windows-1254?Q?erdin=E7_naseri?=) Date: Sat Mar 1 12:16:30 2008 Subject: [HSF] HIT In-Reply-To: <007e01c87ad5$35faa2e0$b3160a06@HZLPC0679> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com><8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <007e01c87ad5$35faa2e0$b3160a06@HZLPC0679> Message-ID: Robertto, I would like to thank you for the link regarding HIT and its treatment. Unfortunately non of the iv forms of DTI ( bivaluridin,lepirudin,argatroban,...) is available here, so when HIT hits! the patient we have to watch the natural history of the process.But subcutaneous Fondaparinux ( not approved by FDA for HIT) did a miracle in our patient.In 15 hours it stoped further decrease in platelet number and stabilized it in 20X1000 and in 3 days the number is 110X 1000.BTW ,22 days after the operation the patient ( neurologic deficit after TCA-Redo TVR thru R thoracotomy) opened her eyes and is following simple commands as squeezing hand) erdinc From hgrmd at aol.com Sat Mar 1 17:32:18 2008 From: hgrmd at aol.com (hgrmd@aol.com) Date: Sat Mar 1 12:32:44 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <6.2.1.2.2.20080301094223.04d76a58@pop.east.cox.net> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com><8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com><007e01c87ad5$35faa2e0$b3160a06@HZLPC0679><89c4ed2d0802290543k2a681f30h14345156899bad9@mail.gmail.com><6.2.1.2.2.20080301094223.04d76a58@pop.east.cox.net> Message-ID: <1371838958-1204392734-cardhu_decombobulator_blackberry.rim.net-616169365-@bxe035.bisx.prod.on.blackberry> Mitch, For the open cases I do a full set on the left and a flutter line on the right. Hal Sent from my Verizon Wireless BlackBerry -----Original Message----- From: Mitch Lirtzman Date: Sat, 01 Mar 2008 09:44:07 To:OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Indications for maze with mitral surgery Hal, When you indicate a " full Cox-maze", do you mean right and left-sided lesions, or just the left atrial set? Thanks. MitchAt 07:43 AM 2/29/2008, you wrote: >ps you can also wave the cautery around for no extra cost !! >Prasanna > >On Fri, Feb 29, 2008 at 6:45 PM, Dr. Roberto Battellini > wrote: > > Don, > > In Leipzig yes, we have the atria open and we have the Cryocath, and takes > > 15 minutes. > > Roberto > > > > -----Urspr?ngliche Nachricht----- > > Von: openheart-l-bounces@lists.hsforum.com > > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Donald Ross > > Gesendet: Freitag, 29. Februar 2008 05:05 > > An: OpenHeart-L@lists.hsforum.com > > Betreff: Re: [HSF] Indications for maze with mitral surgery > > > > > > > > Dear Colleagues, > > Does a history of paroxysmal AF constitute an indication for > > concomitant maze in mitral surgery? > > Don > >_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > >_______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the > policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > >-- >Prasanna Simha M >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Sun Mar 2 00:06:15 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Mar 1 14:35:55 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <1371838958-1204392734-cardhu_decombobulator_blackberry.rim.net-616169365-@bxe035.bisx.prod.on.blackberry> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <007e01c87ad5$35faa2e0$b3160a06@HZLPC0679> <89c4ed2d0802290543k2a681f30h14345156899bad9@mail.gmail.com> <6.2.1.2.2.20080301094223.04d76a58@pop.east.cox.net> <1371838958-1204392734-cardhu_decombobulator_blackberry.rim.net-616169365-@bxe035.bisx.prod.on.blackberry> Message-ID: <89c4ed2d0803011036m6ed06bbem74b909b0fd434b88@mail.gmail.com> I had done a study which I presented in the Asian meet held at Mumbai in which (for chronic Afib) I did emazes in 3 sets - biatrial, left +epicardial right and left only. To get a 90 + conversion rate you need to do a biatrial set of lesions. Lesser mazes give a 60 + approx conversion rate. Prasanna On Sat, Mar 1, 2008 at 11:02 PM, wrote: > Mitch, > For the open cases I do a full set on the left and a flutter line on the right. > > > Hal > Sent from my Verizon Wireless BlackBerry > > -----Original Message----- > > > From: Mitch Lirtzman > > Date: Sat, 01 Mar 2008 09:44:07 > To:OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Indications for maze with mitral surgery > > > Hal, > When you indicate a " full Cox-maze", do you mean right and left-sided > lesions, or just the left atrial set? Thanks. > MitchAt 07:43 AM 2/29/2008, you wrote: > >ps you can also wave the cautery around for no extra cost !! > >Prasanna > > > >On Fri, Feb 29, 2008 at 6:45 PM, Dr. Roberto Battellini > > wrote: > > > Don, > > > In Leipzig yes, we have the atria open and we have the Cryocath, and takes > > > 15 minutes. > > > Roberto > > > > > > -----Urspr?ngliche Nachricht----- > > > Von: openheart-l-bounces@lists.hsforum.com > > > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Donald Ross > > > Gesendet: Freitag, 29. Februar 2008 05:05 > > > An: OpenHeart-L@lists.hsforum.com > > > Betreff: Re: [HSF] Indications for maze with mitral surgery > > > > > > > > > > > > Dear Colleagues, > > > Does a history of paroxysmal AF constitute an indication for > > > concomitant maze in mitral surgery? > > > Don > > >_______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > >_______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > policies and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > > >-- > >Prasanna Simha M > >_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > > OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From dwight_hand at hotmail.com Sat Mar 1 13:29:09 2008 From: dwight_hand at hotmail.com (Dwight Hand) Date: Sat Mar 1 16:29:39 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <89c4ed2d0803011036m6ed06bbem74b909b0fd434b88@mail.gmail.com> References: <3D46BA06-73B5-42BF-9CA5-C7F71597625B@hsforum.com> <8CA489869FAC09F-28C-178C@webmail-stg-d07.sysops.aol.com> <007e01c87ad5$35faa2e0$b3160a06@HZLPC0679> <89c4ed2d0802290543k2a681f30h14345156899bad9@mail.gmail.com> <6.2.1.2.2.20080301094223.04d76a58@pop.east.cox.net> <1371838958-1204392734-cardhu_decombobulator_blackberry.rim.net-616169365-@bxe035.bisx.prod.on.blackberry> <89c4ed2d0803011036m6ed06bbem74b909b0fd434b88@mail.gmail.com> Message-ID: There are a lot of lesion sets out there and a lot of energy sources and a lot of claims about efficacy with variable end points and follow-up methods - some are word of mouth only and have not been published or have stood up to review. Damiano has advanced the Cox Maze III lesion set characterized by open "cut & sew" + cryo technology to a new era paradigm of Bipolar radiofrequency clamp +/- purse-string with cryoablations termed "Maze IV." Others have advocated abreviated lesion sets with alternative energy sources, abreviated follow-up times, and less than optimal results. In order to convince all interested parties (patients, referral sources, third party payors) that AF ablation by whatever means (surgical or interventional) is the way to go, we as surgeons will need to demonstrate procedural efficacy, cost effectiveness, minimal complications, and a minimally invasive approach to displace medical treatment alone. Dwight > Date: Sun, 2 Mar 2008 00:06:15 +0530 > From: prasannasimha@gmail.com > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Indications for maze with mitral surgery > CC: > > I had done a study which I presented in the Asian meet held at Mumbai > in which (for chronic Afib) I did emazes in 3 sets - biatrial, left > +epicardial right and left only. To get a 90 + conversion rate you > need to do a biatrial set of lesions. Lesser mazes give a 60 + approx > conversion rate. > Prasanna > > On Sat, Mar 1, 2008 at 11:02 PM, wrote: > > Mitch, > > For the open cases I do a full set on the left and a flutter line on the right. > > > > > > Hal > > Sent from my Verizon Wireless BlackBerry > > > > -----Original Message----- > > > > > > From: Mitch Lirtzman > > > > Date: Sat, 01 Mar 2008 09:44:07 > > To:OpenHeart-L@lists.hsforum.com > > Subject: Re: [HSF] Indications for maze with mitral surgery > > > > > > Hal, > > When you indicate a " full Cox-maze", do you mean right and left-sided > > lesions, or just the left atrial set? Thanks. > > MitchAt 07:43 AM 2/29/2008, you wrote: > > >ps you can also wave the cautery around for no extra cost !! > > >Prasanna > > > > > >On Fri, Feb 29, 2008 at 6:45 PM, Dr. Roberto Battellini > > > wrote: > > > > Don, > > > > In Leipzig yes, we have the atria open and we have the Cryocath, and takes > > > > 15 minutes. > > > > Roberto > > > > > > > > -----Urspr?ngliche Nachricht----- > > > > Von: openheart-l-bounces@lists.hsforum.com > > > > [mailto:openheart-l-bounces@lists.hsforum.com] Im Auftrag von Donald Ross > > > > Gesendet: Freitag, 29. Februar 2008 05:05 > > > > An: OpenHeart-L@lists.hsforum.com > > > > Betreff: Re: [HSF] Indications for maze with mitral surgery > > > > > > > > > > > > > > > > Dear Colleagues, > > > > Does a history of paroxysmal AF constitute an indication for > > > > concomitant maze in mitral surgery? > > > > Don > > > >_______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > > policies and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > >_______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the > > > policies and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > > > > > > > > > >-- > > >Prasanna Simha M > > >_______________________________________________ > > >OpenHeart-L mailing list > > > > > >Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > >All messages transmitted by the OpenHeart-L are subject to the policies and > > >disclaimers posted at: > > >http://www.hsforum.com/listdisclaim > > >----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From Hgrmd at aol.com Sat Mar 1 17:26:45 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat Mar 1 17:27:18 2008 Subject: [HSF] Indications for maze with mitral surgery Message-ID: Prasanna, Do you ablate the mitral isthmus and the coronary sinus with the cautery? 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) From prasannasimha at gmail.com Sun Mar 2 07:47:44 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sat Mar 1 21:18:13 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: References: Message-ID: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> I ablate the mitral Isthmus and I burn the coronary sinus mouth from the RA as a part of the biatrial set and believe that both are very important. When I did the comparative study the "epicardial right + endocardial left" was designed with elimination of the CS mouth lesion and the superior RA to TV lesion being omitted.The isthmic burn was attemopted in that set by burning externally from IVC to TV. The left atrial set included the mitral isthmic lesion. Lesser mazes did give a lower conversion rate. One of my friends from PGI Chandigarh gave eMAZE as the topic for the thesis of his postgraduate student and his findings also confirmed that an abbreviated set of lesions has a lower conversion rate. On Sun, Mar 2, 2008 at 3:56 AM, wrote: > Prasanna, > Do you ablate the mitral isthmus and the coronary sinus with the cautery? > > 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) > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From benjamin.bidstrup at bigpond.com Sun Mar 2 17:43:42 2008 From: benjamin.bidstrup at bigpond.com (Ben Bidstrup) Date: Sun Mar 2 02:44:25 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> References: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> Message-ID: I agree. I do both atria and my conversion and maintained SR rate is in the 90%. Rarely have I seen flutter. Most of my cases have been persistent AF. >I ablate the mitral Isthmus and I burn the coronary sinus mouth from >the RA as a part of the biatrial set and believe that both are very >important. When I did the comparative study the "epicardial right + >endocardial left" was designed with elimination of the CS mouth lesion >and the superior RA to TV lesion being omitted.The isthmic burn was >attemopted in that set by burning externally from IVC to TV. The left >atrial set included the mitral isthmic lesion. >Lesser mazes did give a lower conversion rate. > >One of my friends from PGI Chandigarh gave eMAZE as the topic for the >thesis of his postgraduate student and his findings also confirmed >that an abbreviated set of lesions has a lower conversion rate. > >On Sun, Mar 2, 2008 at 3:56 AM, wrote: >> Prasanna, >> Do you ablate the mitral isthmus and the coronary sinus with the cautery? >> >> 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) >> >> >> _______________________________________________ >> OpenHeart-L mailing list >> >> Send postings to: >> OpenHeart-L@lists.hsforum.com >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: >> http://mmp.cjp.com/mailman/listinfo/openheart-l >> >> All messages transmitted by the OpenHeart-L are subject to the policies and >> disclaimers posted at: >> http://www.hsforum.com/listdisclaim >> ----------------------------------------- >> > > > >-- >Prasanna Simha M >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: > OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- -- Ben Bidstrup FRACS FRCSEd FEBCTS Consultant Cardiothoracic Surgeon From nkkejriwal at gmail.com Sun Mar 2 21:03:35 2008 From: nkkejriwal at gmail.com (nand kejriwal) Date: Sun Mar 2 03:19:24 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> References: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> Message-ID: Prasanna What lesions do you create in the right atrium? Do you do just the CS mouth lesion or the full set including the one from SVC to IVC and another towards the TV, in all your cases. Nand On 3/2/08, Prasanna Simha M wrote: > > I ablate the mitral Isthmus and I burn the coronary sinus mouth from > the RA as a part of the biatrial set and believe that both are very > important. When I did the comparative study the "epicardial right + > endocardial left" was designed with elimination of the CS mouth lesion > and the superior RA to TV lesion being omitted.The isthmic burn was > attemopted in that set by burning externally from IVC to TV. The left > atrial set included the mitral isthmic lesion. > Lesser mazes did give a lower conversion rate. > > One of my friends from PGI Chandigarh gave eMAZE as the topic for the > thesis of his postgraduate student and his findings also confirmed > that an abbreviated set of lesions has a lower conversion rate. > > > On Sun, Mar 2, 2008 at 3:56 AM, wrote: > > Prasanna, > > Do you ablate the mitral isthmus and the coronary sinus with > the cautery? > > > > 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) > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From nkkejriwal at gmail.com Sun Mar 2 21:43:35 2008 From: nkkejriwal at gmail.com (nand kejriwal) Date: Sun Mar 2 03:50:32 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> Message-ID: Prasanna Did you use a 42 size tricuspid ring? Recently I was going through the brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring used by Pat McCarty is 26 and 28. Nand On 3/1/08, Prasanna Simha M wrote: > > 5 Green and 5 white sutures so 10. Since youThe white are not seen > well as they are enface. > One can be seen well at the base of the strut. > I have seen at least two reports showing no paravalavar rleaks post > op. What could be the mechanism of such a destructive paravalavar leak > in the absence of an overt history of endocarditis ? > Prasanna > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup > wrote: > > > > Prasanna, > > Am I correct in seeing / stating the valve was sewn in with 5 sutures? > > > > > > > > >30 year old male had AVR done 3 years ago by a colleague. At that time > > >Echo was normal. 3 months back patient started becoming breathless. No > > >fever and worsenedprogressively over a month and then came to us.. No > > >fever etc. Counts normal and Echo showed a major valve dehiscence and > > >a rocking valve.There was 1+ MR and severe TR. > > >It was decided to do an AVR +TV Plasty and the MR was acute and > > >thought to be due to annular dilatation. > > >Redo AVR done after TV ring placement (42 No). The approach was via > > >the adheren t RA over the aorta after incising the aorta and extending > > >it into the Torus aorticus of the Right Atrium.This allowed excellent > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with > > >closure of the aortic torus and the aortic wall en mass and the RA was > > >closed thereafter there was a problem weaning so an epicardial showed > > >significant MR so an MVR was done. > > >Patient was weaned off but was not doing well despite increasing > > >supports with normal functioning valves and LV wall acceleration was 5 > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to > > >the ICU with maxi Inotropes after putting an IABPThe patient continued > > >to do poorly immediately on shifting and since his radial showed a > > >better curve than the femoral (actually he was receiving transaortic > > >NTG) so I started Pitressin with a dramatic change in events and > > >stoppage of all other inotropes in1/2 an hour and he continued to do > > >well. and the Pitressin was weaned off after a few hours. I rechecked > > >his drugs (He was in the medical ICU on Inotropes, raised liver > > >parameters (Childs A) , renal failure and had a Eurscore prediction of > > >58 %Mortality) and found that the cardiology residents had restarted > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to > > >receive Intraortic NTG which did not cause problems after Pitressin > > >was started and weaned. > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of > > >reading and trials on imagin and Doppler interrogation of the Hepatic > > >artery - not as difficult as I thought !!) and there is a demonstrable > > >increase in hepatic artery flow velocity (both systolic and diastolic > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5 > > >minutes). > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D. > > >I am not sure of the significance of one data set but it did seem > > >useful and reproducible in the patient (Improvement on restarting > > >NTG). On putting the IABP on you could clearly see diastolic > > >augmentation of hepatic arterial flow too !! > > >Currently off Inotropes , IABP removed (actually did not help much > > >anyway) and extubated. > > > > > >Prasanna > > > > > > > > >-- > > >Prasanna Simha M > > > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg" > > >X-Attachment-Id: f_fd8ro0tk0 > > >Content-Disposition: attachment; > > >filename="transtoric redoaortic valve eml.jpg" > > > > > >Attachment converted: Absolute Genius:transtoric > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD) > > >_______________________________________________ > > >OpenHeart-L mailing list > > > > > >Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > >All messages transmitted by the OpenHeart-L are subject to the > policies and > > >disclaimers posted at: > > >http://www.hsforum.com/listdisclaim > > >----------------------------------------- > > > > > > -- > > Ben Bidstrup FRACS FRCSEd FEBCTS > > Consultant Cardiothoracic Surgeon > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From prasannasimha at gmail.com Sun Mar 2 14:40:57 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 04:11:24 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> Message-ID: <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> 42 refers to the equivalent of a 42 Mitral carpentier Edwards ring ie the central orifice area equals 4.2 cm2. It is my Goretex steel ring. I have used the area of the ATL for siziing. This large ring was itself actually "small" and gave quite a lot of annular reduction as the RV annulus was really huge (One of the "fist goes into the RV" type of ventricles - my fist not Hals as I am nearly half his size) !! As I mentioned previously I place a complete ring with bites in the nodal area on theseptal leaflet of the tricupid valve. Incidentally I was wondering seeing the extreme annular dilatation abutting the septal leaflet wether in such cases a complete ring may actually be better. Incidentally I made a 3D ring with the nadir near the coronary sinus to mimick the tricuspid triplanar position in systole (Not sure if it means much but did give a good competence despite leaflet tethering) Prasanna On Sun, Mar 2, 2008 at 2:13 PM, nand kejriwal wrote: > Prasanna > > Did you use a 42 size tricuspid ring? Recently I was going through the > brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring > used by Pat McCarty is 26 and 28. > > Nand > > > > On 3/1/08, Prasanna Simha M wrote: > > > > 5 Green and 5 white sutures so 10. Since youThe white are not seen > > well as they are enface. > > One can be seen well at the base of the strut. > > I have seen at least two reports showing no paravalavar rleaks post > > op. What could be the mechanism of such a destructive paravalavar leak > > in the absence of an overt history of endocarditis ? > > Prasanna > > > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup > > wrote: > > > > > > Prasanna, > > > Am I correct in seeing / stating the valve was sewn in with 5 sutures? > > > > > > > > > > > > >30 year old male had AVR done 3 years ago by a colleague. At that time > > > >Echo was normal. 3 months back patient started becoming breathless. No > > > >fever and worsenedprogressively over a month and then came to us.. No > > > >fever etc. Counts normal and Echo showed a major valve dehiscence and > > > >a rocking valve.There was 1+ MR and severe TR. > > > >It was decided to do an AVR +TV Plasty and the MR was acute and > > > >thought to be due to annular dilatation. > > > >Redo AVR done after TV ring placement (42 No). The approach was via > > > >the adheren t RA over the aorta after incising the aorta and extending > > > >it into the Torus aorticus of the Right Atrium.This allowed excellent > > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with > > > >closure of the aortic torus and the aortic wall en mass and the RA was > > > >closed thereafter there was a problem weaning so an epicardial showed > > > >significant MR so an MVR was done. > > > >Patient was weaned off but was not doing well despite increasing > > > >supports with normal functioning valves and LV wall acceleration was 5 > > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to > > > >the ICU with maxi Inotropes after putting an IABPThe patient continued > > > >to do poorly immediately on shifting and since his radial showed a > > > >better curve than the femoral (actually he was receiving transaortic > > > >NTG) so I started Pitressin with a dramatic change in events and > > > >stoppage of all other inotropes in1/2 an hour and he continued to do > > > >well. and the Pitressin was weaned off after a few hours. I rechecked > > > >his drugs (He was in the medical ICU on Inotropes, raised liver > > > >parameters (Childs A) , renal failure and had a Eurscore prediction of > > > >58 %Mortality) and found that the cardiology residents had restarted > > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to > > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to > > > >receive Intraortic NTG which did not cause problems after Pitressin > > > >was started and weaned. > > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of > > > >reading and trials on imagin and Doppler interrogation of the Hepatic > > > >artery - not as difficult as I thought !!) and there is a demonstrable > > > >increase in hepatic artery flow velocity (both systolic and diastolic > > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5 > > > >minutes). > > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and > > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D. > > > >I am not sure of the significance of one data set but it did seem > > > >useful and reproducible in the patient (Improvement on restarting > > > >NTG). On putting the IABP on you could clearly see diastolic > > > >augmentation of hepatic arterial flow too !! > > > >Currently off Inotropes , IABP removed (actually did not help much > > > >anyway) and extubated. > > > > > > > >Prasanna > > > > > > > > > > > >-- > > > >Prasanna Simha M > > > > > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg" > > > >X-Attachment-Id: f_fd8ro0tk0 > > > >Content-Disposition: attachment; > > > >filename="transtoric redoaortic valve eml.jpg" > > > > > > > >Attachment converted: Absolute Genius:transtoric > > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD) > > > >_______________________________________________ > > > >OpenHeart-L mailing list > > > > > > > >Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > >All messages transmitted by the OpenHeart-L are subject to the > > policies and > > > >disclaimers posted at: > > > >http://www.hsforum.com/listdisclaim > > > >----------------------------------------- > > > > > > > > > -- > > > Ben Bidstrup FRACS FRCSEd FEBCTS > > > Consultant Cardiothoracic Surgeon > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 14:47:19 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 04:17:43 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: References: <89c4ed2d0803011817y54c44c88naec8fc456ceb9851@mail.gmail.com> Message-ID: <89c4ed2d0803020117y14ab1875r44799f46c8a73785@mail.gmail.com> The right atrial lesions are One from the SVC to IVC. Two from the previous lesion crossing the crista to the atrial incision. Three from the IVC via the tricuspid isthmus to the tricuspid valve. Four Burn the mouth of the coronary sinus with the burn going in the mouth at the triangle of Koch Five Join the SVC_IVC lesion to the CS and then to the TV isthmic burn Six - from SVC to above the anteroseptal commissure of the tricuspid valve Seventh - is to go from the RA incision over the RA appendage on to the dome of the LA keeping a 3mm gap over the SA nodal artery. I have omitted this when I have taken lesion 6 at times in redos with no difference in conversion rates so I think lesion 7 may be omitted. Prasanna On Sun, Mar 2, 2008 at 1:33 PM, nand kejriwal wrote: > Prasanna > > What lesions do you create in the right atrium? Do you do just the CS mouth > lesion or the full set including the one from SVC to IVC and another towards > the TV, in all your cases. > > Nand > > > > On 3/2/08, Prasanna Simha M wrote: > > > > I ablate the mitral Isthmus and I burn the coronary sinus mouth from > > the RA as a part of the biatrial set and believe that both are very > > important. When I did the comparative study the "epicardial right + > > endocardial left" was designed with elimination of the CS mouth lesion > > and the superior RA to TV lesion being omitted.The isthmic burn was > > attemopted in that set by burning externally from IVC to TV. The left > > atrial set included the mitral isthmic lesion. > > Lesser mazes did give a lower conversion rate. > > > > One of my friends from PGI Chandigarh gave eMAZE as the topic for the > > thesis of his postgraduate student and his findings also confirmed > > that an abbreviated set of lesions has a lower conversion rate. > > > > > > On Sun, Mar 2, 2008 at 3:56 AM, wrote: > > > Prasanna, > > > Do you ablate the mitral isthmus and the coronary sinus with > > the cautery? > > > > > > 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) > > > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > > > > > -- > > > > Prasanna Simha M > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 14:51:01 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 04:21:31 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> Message-ID: <89c4ed2d0803020121q5b865f63qc29789fd57ada252@mail.gmail.com> The ring sizers - should be printed out in actual size setting while printing. I can send the PDF to anyone who wants it. Prasanna On Sun, Mar 2, 2008 at 2:40 PM, Prasanna Simha M wrote: > 42 refers to the equivalent of a 42 Mitral carpentier Edwards ring ie > the central orifice area equals 4.2 cm2. It is my Goretex steel ring. > I have used the area of the ATL for siziing. This large ring was > itself actually "small" and gave quite a lot of annular reduction as > the RV annulus was really huge (One of the "fist goes into the RV" > type of ventricles - my fist not Hals as I am nearly half his size) !! > As I mentioned previously I place a complete ring with bites in the > nodal area on theseptal leaflet of the tricupid valve. Incidentally I > was wondering seeing the extreme annular dilatation abutting the > septal leaflet wether in such cases a complete ring may actually be > better. > Incidentally I made a 3D ring with the nadir near the coronary sinus > to mimick the tricuspid triplanar position in systole (Not sure if it > means much but did give a good competence despite leaflet tethering) > Prasanna > > > > > On Sun, Mar 2, 2008 at 2:13 PM, nand kejriwal wrote: > > Prasanna > > > > Did you use a 42 size tricuspid ring? Recently I was going through the > > brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring > > used by Pat McCarty is 26 and 28. > > > > Nand > > > > > > > > On 3/1/08, Prasanna Simha M wrote: > > > > > > 5 Green and 5 white sutures so 10. Since youThe white are not seen > > > well as they are enface. > > > One can be seen well at the base of the strut. > > > I have seen at least two reports showing no paravalavar rleaks post > > > op. What could be the mechanism of such a destructive paravalavar leak > > > in the absence of an overt history of endocarditis ? > > > Prasanna > > > > > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup > > > wrote: > > > > > > > > Prasanna, > > > > Am I correct in seeing / stating the valve was sewn in with 5 sutures? > > > > > > > > > > > > > > > > >30 year old male had AVR done 3 years ago by a colleague. At that time > > > > >Echo was normal. 3 months back patient started becoming breathless. No > > > > >fever and worsenedprogressively over a month and then came to us.. No > > > > >fever etc. Counts normal and Echo showed a major valve dehiscence and > > > > >a rocking valve.There was 1+ MR and severe TR. > > > > >It was decided to do an AVR +TV Plasty and the MR was acute and > > > > >thought to be due to annular dilatation. > > > > >Redo AVR done after TV ring placement (42 No). The approach was via > > > > >the adheren t RA over the aorta after incising the aorta and extending > > > > >it into the Torus aorticus of the Right Atrium.This allowed excellent > > > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with > > > > >closure of the aortic torus and the aortic wall en mass and the RA was > > > > >closed thereafter there was a problem weaning so an epicardial showed > > > > >significant MR so an MVR was done. > > > > >Patient was weaned off but was not doing well despite increasing > > > > >supports with normal functioning valves and LV wall acceleration was 5 > > > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to > > > > >the ICU with maxi Inotropes after putting an IABPThe patient continued > > > > >to do poorly immediately on shifting and since his radial showed a > > > > >better curve than the femoral (actually he was receiving transaortic > > > > >NTG) so I started Pitressin with a dramatic change in events and > > > > >stoppage of all other inotropes in1/2 an hour and he continued to do > > > > >well. and the Pitressin was weaned off after a few hours. I rechecked > > > > >his drugs (He was in the medical ICU on Inotropes, raised liver > > > > >parameters (Childs A) , renal failure and had a Eurscore prediction of > > > > >58 %Mortality) and found that the cardiology residents had restarted > > > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to > > > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to > > > > >receive Intraortic NTG which did not cause problems after Pitressin > > > > >was started and weaned. > > > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of > > > > >reading and trials on imagin and Doppler interrogation of the Hepatic > > > > >artery - not as difficult as I thought !!) and there is a demonstrable > > > > >increase in hepatic artery flow velocity (both systolic and diastolic > > > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5 > > > > >minutes). > > > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and > > > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D. > > > > >I am not sure of the significance of one data set but it did seem > > > > >useful and reproducible in the patient (Improvement on restarting > > > > >NTG). On putting the IABP on you could clearly see diastolic > > > > >augmentation of hepatic arterial flow too !! > > > > >Currently off Inotropes , IABP removed (actually did not help much > > > > >anyway) and extubated. > > > > > > > > > >Prasanna > > > > > > > > > > > > > > >-- > > > > >Prasanna Simha M > > > > > > > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg" > > > > >X-Attachment-Id: f_fd8ro0tk0 > > > > >Content-Disposition: attachment; > > > > >filename="transtoric redoaortic valve eml.jpg" > > > > > > > > > >Attachment converted: Absolute Genius:transtoric > > > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD) > > > > >_______________________________________________ > > > > >OpenHeart-L mailing list > > > > > > > > > >Send postings to: > > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > > >All messages transmitted by the OpenHeart-L are subject to the > > > policies and > > > > >disclaimers posted at: > > > > >http://www.hsforum.com/listdisclaim > > > > >----------------------------------------- > > > > > > > > > > > > -- > > > > Ben Bidstrup FRACS FRCSEd FEBCTS > > > > Consultant Cardiothoracic Surgeon > > > > _______________________________________________ > > > > OpenHeart-L mailing list > > > > > > > > Send postings to: > > > > OpenHeart-L@lists.hsforum.com > > > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > > disclaimers posted at: > > > > http://www.hsforum.com/listdisclaim > > > > ----------------------------------------- > > > > > > > > > > > > > > > > -- > > > Prasanna Simha M > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > -- Prasanna Simha M -------------- next part -------------- A non-text attachment was scrubbed... Name: ring sizers.jpg Type: image/jpeg Size: 70874 bytes Desc: not available Url : http://mmp.cjp.com/pipermail/openheart-l/attachments/20080302/54d84be3/ringsizers-0001.jpg From Hgrmd at aol.com Sun Mar 2 07:40:52 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 07:42:27 2008 Subject: [HSF] Indications for maze with mitral surgery Message-ID: Prasanna, How do you ablate the mitral isthmus in patients with a left dominant system? Have you ever injured the CX in such cases? 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) From Hgrmd at aol.com Sun Mar 2 07:43:11 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 07:47:28 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve Message-ID: Nand, I insert 90-100 MC3's per year. Like McCarthy, I generally use 26 or 28 mm. In fact, I wish they made 24's for some of my tiny ladies. 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) From prasannasimha at gmail.com Sun Mar 2 18:18:50 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 07:49:09 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: References: Message-ID: <89c4ed2d0803020448x1573c69h8e593712313de2a9@mail.gmail.com> My lesion line has always been at 5Oclock and I haven't had any problems with this. It was set at 5 O'clock so that it sits over the dimunitive area of the distal circumflex.Practically I have not had problems. The circumflex is also overlapped with the coronary sinus at this place. Prasanna On Sun, Mar 2, 2008 at 6:10 PM, wrote: > Prasanna, > How do you ablate the mitral isthmus in patients with a left dominant > system? Have you ever injured the CX in such cases? > > > > 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) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 18:21:40 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 07:58:55 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: Message-ID: <89c4ed2d0803020451m93e6007o1d7aa8b7d1562fc6@mail.gmail.com> Hal, can you do me a favour- can you overlap the MC3 ring (say 28) over a regular CE ring sizer and tell me which correspond.I have a suspicion that these numbers (like other valve sizers ) are not equivalent. Prasanna On Sun, Mar 2, 2008 at 6:13 PM, wrote: > Nand, > I insert 90-100 MC3's per year. Like McCarthy, I generally use 26 or 28 > mm. In fact, I wish they made 24's for some of my tiny ladies. > > 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) > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Sun Mar 2 08:00:01 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 08:04:18 2008 Subject: [HSF] Indications for maze with mitral surgery Message-ID: Prasanna, It's a little hard to follow, but your lesion set is not the same as the one described in the Cox-maze III. It doesn't contain a cavo-tricuspid isthmus lesion. Around '03, at an AF symposium at the STS in San Antonio, Dr. Cox publicly stated that he felt that the right atrial flutter line (cavo-tricuspid isthmus) was all that was probably necessary for the right side. He has since reneged and stated that a full set of right sided lesions is necessary. I recently reminded him of what he said, and he stated that he didn't think it would make a huge difference either way. Regardless, I jumped on what he said back then and just started doing just the flutter line for the right side. I do the flutter line after I release the clamp, i.e., the heart is warm and beating. A few times I've noticed before making the flutter line that the atrium is in flutter. Within 20 seconds of applying Cryocath along the cavo-tricuspid isthmus, the heart will convert to NSR. It's fun to observe. I'm presenting my results in 180 patients in a poster at ISMICS this June. With over 2/3's in continuous AF, the success rate is in the 90's. 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) From anianyanwu at hotmail.com Sun Mar 2 13:06:08 2008 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Mar 2 08:06:57 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> Message-ID: Prasanna 42 seems gigantic - how do you determine the size of your tricuspid ring? In our experience we rarely size a tricuspid larger than a 32 and like Hal the majority sizes are 26 and 28. Indeed the largest available sizes for both the Carpentier ring and MC3 ring is 36mm. Ani > Date: Sun, 2 Mar 2008 14:40:57 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Image of the week - Trans toric approach to the aortic valve> CC: > > 42 refers to the equivalent of a 42 Mitral carpentier Edwards ring ie> the central orifice area equals 4.2 cm2. It is my Goretex steel ring.> I have used the area of the ATL for siziing. This large ring was> itself actually "small" and gave quite a lot of annular reduction as> the RV annulus was really huge (One of the "fist goes into the RV"> type of ventricles - my fist not Hals as I am nearly half his size) !!> As I mentioned previously I place a complete ring with bites in the> nodal area on theseptal leaflet of the tricupid valve. Incidentally I> was wondering seeing the extreme annular dilatation abutting the> septal leaflet wether in such cases a complete ring may actually be> better.> Incidentally I made a 3D ring with the nadir near the coronary sinus> to mimick the tricuspid triplanar position in systole (Not sure if it> means much but did give a good competence despite leaflet tethering)> Prasanna> > > On Sun, Mar 2, 2008 at 2:13 PM, nand kejriwal wrote:> > Prasanna> >> > Did you use a 42 size tricuspid ring? Recently I was going through the> > brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring> > used by Pat McCarty is 26 and 28.> >> > Nand> >> >> >> > On 3/1/08, Prasanna Simha M wrote:> > >> > > 5 Green and 5 white sutures so 10. Since youThe white are not seen> > > well as they are enface.> > > One can be seen well at the base of the strut.> > > I have seen at least two reports showing no paravalavar rleaks post> > > op. What could be the mechanism of such a destructive paravalavar leak> > > in the absence of an overt history of endocarditis ?> > > Prasanna> > >> > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup> > > wrote:> > > >> > > > Prasanna,> > > > Am I correct in seeing / stating the valve was sewn in with 5 sutures?> > > >> > > >> > > >> > > > >30 year old male had AVR done 3 years ago by a colleague. At that time> > > > >Echo was normal. 3 months back patient started becoming breathless. No> > > > >fever and worsenedprogressively over a month and then came to us.. No> > > > >fever etc. Counts normal and Echo showed a major valve dehiscence and> > > > >a rocking valve.There was 1+ MR and severe TR.> > > > >It was decided to do an AVR +TV Plasty and the MR was acute and> > > > >thought to be due to annular dilatation.> > > > >Redo AVR done after TV ring placement (42 No). The approach was via> > > > >the adheren t RA over the aorta after incising the aorta and extending> > > > >it into the Torus aorticus of the Right Atrium.This allowed excellent> > > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with> > > > >closure of the aortic torus and the aortic wall en mass and the RA was> > > > >closed thereafter there was a problem weaning so an epicardial showed> > > > >significant MR so an MVR was done.> > > > >Patient was weaned off but was not doing well despite increasing> > > > >supports with normal functioning valves and LV wall acceleration was 5> > > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to> > > > >the ICU with maxi Inotropes after putting an IABPThe patient continued> > > > >to do poorly immediately on shifting and since his radial showed a> > > > >better curve than the femoral (actually he was receiving transaortic> > > > >NTG) so I started Pitressin with a dramatic change in events and> > > > >stoppage of all other inotropes in1/2 an hour and he continued to do> > > > >well. and the Pitressin was weaned off after a few hours. I rechecked> > > > >his drugs (He was in the medical ICU on Inotropes, raised liver> > > > >parameters (Childs A) , renal failure and had a Eurscore prediction of> > > > >58 %Mortality) and found that the cardiology residents had restarted> > > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to> > > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to> > > > >receive Intraortic NTG which did not cause problems after Pitressin> > > > >was started and weaned.> > > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of> > > > >reading and trials on imagin and Doppler interrogation of the Hepatic> > > > >artery - not as difficult as I thought !!) and there is a demonstrable> > > > >increase in hepatic artery flow velocity (both systolic and diastolic> > > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5> > > > >minutes).> > > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and> > > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D.> > > > >I am not sure of the significance of one data set but it did seem> > > > >useful and reproducible in the patient (Improvement on restarting> > > > >NTG). On putting the IABP on you could clearly see diastolic> > > > >augmentation of hepatic arterial flow too !!> > > > >Currently off Inotropes , IABP removed (actually did not help much> > > > >anyway) and extubated.> > > > >> > > > >Prasanna> > > > >> > > > >> > > > >--> > > > >Prasanna Simha M> > > > >> > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg"> > > > >X-Attachment-Id: f_fd8ro0tk0> > > > >Content-Disposition: attachment;> > > > >filename="transtoric redoaortic valve eml.jpg"> > > > >> > > > >Attachment converted: Absolute Genius:transtoric> > > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD)> > > > >_______________________________________________> > > > >OpenHeart-L mailing list> > > > >> > > > >Send postings to:> > > > > OpenHeart-L@lists.hsforum.com> > > > >> > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l> > > > >> > > > >All messages transmitted by the OpenHeart-L are subject to the> > > policies and> > > > >disclaimers posted at:> > > > >http://www.hsforum.com/listdisclaim> > > > >-----------------------------------------> > > >> > > >> > > > --> > > > Ben Bidstrup FRACS FRCSEd FEBCTS> > > > Consultant Cardiothoracic Surgeon> > > > _______________________________________________> > > > OpenHeart-L mailing list> > > >> > > > Send postings to:> > > > OpenHeart-L@lists.hsforum.com> > > >> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >> > > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > > disclaimers posted at:> > > > http://www.hsforum.com/listdisclaim> > > > -----------------------------------------> > > >> > >> > >> > >> > > --> > > Prasanna Simha M> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L@lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> > > -----------------------------------------> > >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- _________________________________________________________________ Free games, great prizes - get gaming at Gamesbox. http://www.searchgamesbox.com From Hgrmd at aol.com Sun Mar 2 08:05:50 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 08:07:30 2008 Subject: [HSF] Indications for maze with mitral surgery Message-ID: Prasanna, In a left dominant system, there is no diminuitive area of the CX. Obviously, it works well for you, but I would be afraid of thermal damage to the CX in those cases. Even Damiano, a big bipolar AF fan, uses cryo (Frigitronics--reusable probes from Cooper Medical) when ablating the mitral isthmus and coronary sinus. 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) From Hgrmd at aol.com Sun Mar 2 08:07:11 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 08:11:28 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve Message-ID: Prasanna, I'll try to remember. However, I can tell you that a 28 MC3 sizer is much smaller than a 40 Classic sizer. 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) From prasannasimha at gmail.com Sun Mar 2 18:47:01 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 08:17:26 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: Message-ID: <89c4ed2d0803020517mf4910c8u18d1e79d545581ca@mail.gmail.com> I think so too but I am curious to see how these rings are ereally "numbered". Prasanna On Sun, Mar 2, 2008 at 6:37 PM, wrote: > Prasanna, > I'll try to remember. However, I can tell you that a 28 MC3 sizer is much > smaller than a 40 Classic sizer. > > > 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) > _______________________________________________ > > > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 18:51:00 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 08:21:30 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: References: Message-ID: <89c4ed2d0803020521x503558f1rb9f4266fee146b7c@mail.gmail.com> There may be one difference I don't "cook" with the probes but set up an arc which is based on its cutting off as soon as dehydration occurs and so is self regulating. Anyway I havent had an issue after burning over 600 cases !! The methodolgy used are different. Prasanna On Sun, Mar 2, 2008 at 6:35 PM, wrote: > Prasanna, > In a left dominant system, there is no diminuitive area of the CX. > Obviously, it works well for you, but I would be afraid of thermal damage to the CX > in those cases. Even Damiano, a big bipolar AF fan, uses cryo > (Frigitronics--reusable probes from Cooper Medical) when ablating the mitral isthmus and > coronary sinus. > > > > 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) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 18:47:27 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 08:24:08 2008 Subject: [HSF] Indications for maze with mitral surgery In-Reply-To: References: Message-ID: <89c4ed2d0803020517j3ef15a6ckcc7bf64425363ee7@mail.gmail.com> Hal there is a lesion in the cavo tricuspid lesion . It is the lesion that extends from the IVC to the tricuspid Isthmus and icourses through the right atrial Isthmyus. I consider it a very important lesion too.(The exact lesions are in the article published in HSF some years back) I have actually observed the same . In fact since I do it in the reverse manner ie beating heart prior to cross clamping , I have noticed that nearly half of the patients actually start to go to sinus rhythm or have a slowing of rate with the placement of right sided lesions. Prasanna On Sun, Mar 2, 2008 at 6:30 PM, wrote: > Prasanna, > It's a little hard to follow, but your lesion set is not the same as the > one described in the Cox-maze III. It doesn't contain a cavo-tricuspid > isthmus lesion. Around '03, at an AF symposium at the STS in San Antonio, Dr. Cox > publicly stated that he felt that the right atrial flutter line > (cavo-tricuspid isthmus) was all that was probably necessary for the right side. He has > since reneged and stated that a full set of right sided lesions is necessary. > I recently reminded him of what he said, and he stated that he didn't think > it would make a huge difference either way. Regardless, I jumped on what he > said back then and just started doing just the flutter line for the right > side. > I do the flutter line after I release the clamp, i.e., the heart is warm > and beating. A few times I've noticed before making the flutter line that the > atrium is in flutter. Within 20 seconds of applying Cryocath along the > cavo-tricuspid isthmus, the heart will convert to NSR. It's fun to observe. > I'm presenting my results in 180 patients in a poster at ISMICS this June. > With over 2/3's in continuous AF, the success rate is in the 90's. > > > > 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) > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Mar 2 19:03:36 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 08:33:59 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> Message-ID: <89c4ed2d0803020533i44afae8p7931d35cfc9641b2@mail.gmail.com> Largest Mitral size (Carpentier classic Mitral) is 40 and Tricuspid is 36. I have based mine to coincide with corresponding CE internal orifice area but designed them individually.(Needed lot of graph paper etc etc and area calculations when I made the basic designs). My tricuspid ring is the mittral inverted !!(as you can see in the picture with the "flat " end on the septal leaflet. Incidentally Mitral 36 has an area of 586 mm2 and 36 Tricuspid has an area of 626 mm2. Mitral 40 has an area of 736 mm2. Prasanna On Sun, Mar 2, 2008 at 6:36 PM, Ani Anyanwu wrote: > Prasanna > > 42 seems gigantic - how do you determine the size of your tricuspid ring? In our experience we rarely size a tricuspid larger than a 32 and like Hal the majority sizes are 26 and 28. Indeed the largest available sizes for both the Carpentier ring and MC3 ring is 36mm. > > Ani > > > > > > Date: Sun, 2 Mar 2008 14:40:57 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Image of the week - Trans toric approach to the aortic valve> CC: > > 42 refers to the equivalent of a 42 Mitral carpentier Edwards ring ie> the central orifice area equals 4.2 cm2. It is my Goretex steel ring.> I have used the area of the ATL for siziing. This large ring was> itself actually "small" and gave quite a lot of annular reduction as> the RV annulus was really huge (One of the "fist goes into the RV"> type of ventricles - my fist not Hals as I am nearly half his size) !!> As I mentioned previously I place a complete ring with bites in the> nodal area on theseptal leaflet of the tricupid valve. Incidentally I> was wondering seeing the extreme annular dilatation abutting the> septal leaflet wether in such cases a complete ring may actually be> better.> Incidentally I made a 3D ring with the nadir near the coronary sinus> to mimick the tricuspid triplanar position in systole (Not sure if it> means much but did give a good competence despite leaflet tethering)> Prasanna> > > On Sun, Mar 2, 2008 at 2:13 PM, nand kejriwal wrote:> > Prasanna> >> > Did you use a 42 size tricuspid ring? Recently I was going through the> > brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring> > used by Pat McCarty is 26 and 28.> >> > Nand> >> >> >> > On 3/1/08, Prasanna Simha M wrote:> > >> > > 5 Green and 5 white sutures so 10. Since youThe white are not seen> > > well as they are enface.> > > One can be seen well at the base of the strut.> > > I have seen at least two reports showing no paravalavar rleaks post> > > op. What could be the mechanism of such a destructive paravalavar leak> > > in the absence of an overt history of endocarditis ?> > > Prasanna> > >> > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup> > > wrote:> > > >> > > > Prasanna,> > > > Am I correct in seeing / stating the valve was sewn in with 5 sutures?> > > >> > > >> > > >> > > > >30 year old male had AVR done 3 years ago by a colleague. At that time> > > > >Echo was normal. 3 months back patient started becoming breathless. No> > > > >fever and worsenedprogressively over a month and then came to us.. No> > > > >fever etc. Counts normal and Echo showed a major valve dehiscence and> > > > >a rocking valve.There was 1+ MR and severe TR.> > > > >It was decided to do an AVR +TV Plasty and the MR was acute and> > > > >thought to be due to annular dilatation.> > > > >Redo AVR done after TV ring placement (42 No). The approach was via> > > > >the adheren t RA over the aorta after incising the aorta and extending> > > > >it into the Torus aorticus of the Right Atrium.This allowed excellent> > > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with> > > > >closure of the aortic torus and the aortic wall en mass and the RA was> > > > >closed thereafter there was a problem weaning so an epicardial showed> > > > >significant MR so an MVR was done.> > > > >Patient was weaned off but was not doing well despite increasing> > > > >supports with normal functioning valves and LV wall acceleration was 5> > > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to> > > > >the ICU with maxi Inotropes after putting an IABPThe patient continued> > > > >to do poorly immediately on shifting and since his radial showed a> > > > >better curve than the femoral (actually he was receiving transaortic> > > > >NTG) so I started Pitressin with a dramatic change in events and> > > > >stoppage of all other inotropes in1/2 an hour and he continued to do> > > > >well. and the Pitressin was weaned off after a few hours. I rechecked> > > > >his drugs (He was in the medical ICU on Inotropes, raised liver> > > > >parameters (Childs A) , renal failure and had a Eurscore prediction of> > > > >58 %Mortality) and found that the cardiology residents had restarted> > > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to> > > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to> > > > >receive Intraortic NTG which did not cause problems after Pitressin> > > > >was started and weaned.> > > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of> > > > >reading and trials on imagin and Doppler interrogation of the Hepatic> > > > >artery - not as difficult as I thought !!) and there is a demonstrable> > > > >increase in hepatic artery flow velocity (both systolic and diastolic> > > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5> > > > >minutes).> > > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and> > > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D.> > > > >I am not sure of the significance of one data set but it did seem> > > > >useful and reproducible in the patient (Improvement on restarting> > > > >NTG). On putting the IABP on you could clearly see diastolic> > > > >augmentation of hepatic arterial flow too !!> > > > >Currently off Inotropes , IABP removed (actually did not help much> > > > >anyway) and extubated.> > > > >> > > > >Prasanna> > > > >> > > > >> > > > >--> > > > >Prasanna Simha M> > > > >> > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg"> > > > >X-Attachment-Id: f_fd8ro0tk0> > > > >Content-Disposition: attachment;> > > > >filename="transtoric redoaortic valve eml.jpg"> > > > >> > > > >Attachment converted: Absolute Genius:transtoric> > > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD)> > > > >_______________________________________________> > > > >OpenHeart-L mailing list> > > > >> > > > >Send postings to:> > > > > OpenHeart-L@lists.hsforum.com> > > > >> > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l> > > > >> > > > >All messages transmitted by the OpenHeart-L are subject to the> > > policies and> > > > >disclaimers posted at:> > > > >http://www.hsforum.com/listdisclaim> > > > >-----------------------------------------> > > >> > > >> > > > --> > > > Ben Bidstrup FRACS FRCSEd FEBCTS> > > > Consultant Cardiothoracic Surgeon> > > > _______________________________________________> > > > OpenHeart-L mailing list> > > >> > > > Send postings to:> > > > OpenHeart-L@lists.hsforum.com> > > >> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >> > > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > > disclaimers posted at:> > > > http://www.hsforum.com/listdisclaim> > > > -----------------------------------------> > > >> > >> > >> > >> > > --> > > Prasanna Simha M> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L@lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> > > -----------------------------------------> > >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- > _________________________________________________________________ > Free games, great prizes - get gaming at Gamesbox. > http://www.searchgamesbox.com_______________________________________________ > > > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From Hgrmd at aol.com Sun Mar 2 08:34:44 2008 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Mar 2 08:38:57 2008 Subject: [HSF] Indications for maze with mitral surgery Message-ID: Prasanna, Go back and look at Cox's lesion set for the maze III. There is no line from the posterior tricuspid annulus to the IVC. Obviously, you do it with success, but it's not a part of maze III. I've personally discussed this with Jimmy, and he even points that out. 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) From prasannasimha at gmail.com Sun Mar 2 18:46:07 2008 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Mar 2 08:41:40 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> Message-ID: <89c4ed2d0803020516i1cc8a698m21407982567df352@mail.gmail.com> I do agree that these sizes are gigantic and I have rarely used such large sizes. I use the former sizer to cover the ATL (the same sizes that you can see in the JPEG that I sent earlier)and use that size. In the cases where I have used such a big ring the RV and Tricuspid annulus were huge. In fact the septal area extended 4 cms from the ends of the sizer. As I said the RV was so huge that probably I could swim in it and I am not sure if I could reliably cram the ring inside. I have got No TR in the case with a good coaptation line on Control Echo done both on table and 24 hours later. In fact I used to not make and keep size 40 and 42 earlier but after having to make one in a hurry in the past I have kept them ready just in case and I have used them occasionaly . Prasanna On Sun, Mar 2, 2008 at 6:36 PM, Ani Anyanwu wrote: > Prasanna > > 42 seems gigantic - how do you determine the size of your tricuspid ring? In our experience we rarely size a tricuspid larger than a 32 and like Hal the majority sizes are 26 and 28. Indeed the largest available sizes for both the Carpentier ring and MC3 ring is 36mm. > > Ani > > > > > > Date: Sun, 2 Mar 2008 14:40:57 +0530> From: prasannasimha@gmail.com> To: OpenHeart-L@lists.hsforum.com> Subject: Re: [HSF] Image of the week - Trans toric approach to the aortic valve> CC: > > 42 refers to the equivalent of a 42 Mitral carpentier Edwards ring ie> the central orifice area equals 4.2 cm2. It is my Goretex steel ring.> I have used the area of the ATL for siziing. This large ring was> itself actually "small" and gave quite a lot of annular reduction as> the RV annulus was really huge (One of the "fist goes into the RV"> type of ventricles - my fist not Hals as I am nearly half his size) !!> As I mentioned previously I place a complete ring with bites in the> nodal area on theseptal leaflet of the tricupid valve. Incidentally I> was wondering seeing the extreme annular dilatation abutting the> septal leaflet wether in such cases a complete ring may actually be> better.> Incidentally I made a 3D ring with the nadir near the coronary sinus> to mimick the tricuspid triplanar position in systole (Not sure if it> means much but did give a good competence despite leaflet tethering)> Prasanna> > > On Sun, Mar 2, 2008 at 2:13 PM, nand kejriwal wrote:> > Prasanna> >> > Did you use a 42 size tricuspid ring? Recently I was going through the> > brochure provided by Edwards. It mentioned that the commonest sizeMC3 ring> > used by Pat McCarty is 26 and 28.> >> > Nand> >> >> >> > On 3/1/08, Prasanna Simha M wrote:> > >> > > 5 Green and 5 white sutures so 10. Since youThe white are not seen> > > well as they are enface.> > > One can be seen well at the base of the strut.> > > I have seen at least two reports showing no paravalavar rleaks post> > > op. What could be the mechanism of such a destructive paravalavar leak> > > in the absence of an overt history of endocarditis ?> > > Prasanna> > >> > > On Sat, Mar 1, 2008 at 4:14 AM, Ben Bidstrup> > > wrote:> > > >> > > > Prasanna,> > > > Am I correct in seeing / stating the valve was sewn in with 5 sutures?> > > >> > > >> > > >> > > > >30 year old male had AVR done 3 years ago by a colleague. At that time> > > > >Echo was normal. 3 months back patient started becoming breathless. No> > > > >fever and worsenedprogressively over a month and then came to us.. No> > > > >fever etc. Counts normal and Echo showed a major valve dehiscence and> > > > >a rocking valve.There was 1+ MR and severe TR.> > > > >It was decided to do an AVR +TV Plasty and the MR was acute and> > > > >thought to be due to annular dilatation.> > > > >Redo AVR done after TV ring placement (42 No). The approach was via> > > > >the adheren t RA over the aorta after incising the aorta and extending> > > > >it into the Torus aorticus of the Right Atrium.This allowed excellent> > > > >exposure and a 25 mm Chitra vavle was placed. Closure was done with> > > > >closure of the aortic torus and the aortic wall en mass and the RA was> > > > >closed thereafter there was a problem weaning so an epicardial showed> > > > >significant MR so an MVR was done.> > > > >Patient was weaned off but was not doing well despite increasing> > > > >supports with normal functioning valves and LV wall acceleration was 5> > > > >cms/ sec and so was judged weanable (> 4 cms/sec) and was shifted to> > > > >the ICU with maxi Inotropes after putting an IABPThe patient continued> > > > >to do poorly immediately on shifting and since his radial showed a> > > > >better curve than the femoral (actually he was receiving transaortic> > > > >NTG) so I started Pitressin with a dramatic change in events and> > > > >stoppage of all other inotropes in1/2 an hour and he continued to do> > > > >well. and the Pitressin was weaned off after a few hours. I rechecked> > > > >his drugs (He was in the medical ICU on Inotropes, raised liver> > > > >parameters (Childs A) , renal failure and had a Eurscore prediction of> > > > >58 %Mortality) and found that the cardiology residents had restarted> > > > >ACE Inhibitors that I had asked to discontinue 24 hours prior to> > > > >surgery. He was vasoplegic.and responded to Pitressin. He contined to> > > > >receive Intraortic NTG which did not cause problems after Pitressin> > > > >was started and weaned.> > > > >I did a Hepatic artery Doppler estimation (Last few daysdid a bit of> > > > >reading and trials on imagin and Doppler interrogation of the Hepatic> > > > >artery - not as difficult as I thought !!) and there is a demonstrable> > > > >increase in hepatic artery flow velocity (both systolic and diastolic> > > > >) with Intraortic NTG and a decrease on stopping it and waiting for 5> > > > >minutes).> > > > >On NTG Peak Systolic (S) 71 cms/sec Diastolic (D) 48 Off NTG 63 and> > > > >35. 12 Hours Later On NTG 74 (S) and 42 (D) and Off NTG 61S and 35 D.> > > > >I am not sure of the significance of one data set but it did seem> > > > >useful and reproducible in the patient (Improvement on restarting> > > > >NTG). On putting the IABP on you could clearly see diastolic> > > > >augmentation of hepatic arterial flow too !!> > > > >Currently off Inotropes , IABP removed (actually did not help much> > > > >anyway) and extubated.> > > > >> > > > >Prasanna> > > > >> > > > >> > > > >--> > > > >Prasanna Simha M> > > > >> > > > >Content-Type: image/jpeg; name="transtoric redoaortic valve eml.jpg"> > > > >X-Attachment-Id: f_fd8ro0tk0> > > > >Content-Disposition: attachment;> > > > >filename="transtoric redoaortic valve eml.jpg"> > > > >> > > > >Attachment converted: Absolute Genius:transtoric> > > > >redoaorti#CFA8DD.jpg (JPEG/?IC?) (00CFA8DD)> > > > >_______________________________________________> > > > >OpenHeart-L mailing list> > > > >> > > > >Send postings to:> > > > > OpenHeart-L@lists.hsforum.com> > > > >> > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l> > > > >> > > > >All messages transmitted by the OpenHeart-L are subject to the> > > policies and> > > > >disclaimers posted at:> > > > >http://www.hsforum.com/listdisclaim> > > > >-----------------------------------------> > > >> > > >> > > > --> > > > Ben Bidstrup FRACS FRCSEd FEBCTS> > > > Consultant Cardiothoracic Surgeon> > > > _______________________________________________> > > > OpenHeart-L mailing list> > > >> > > > Send postings to:> > > > OpenHeart-L@lists.hsforum.com> > > >> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > > >> > > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > > disclaimers posted at:> > > > http://www.hsforum.com/listdisclaim> > > > -----------------------------------------> > > >> > >> > >> > >> > > --> > > Prasanna Simha M> > > _______________________________________________> > > OpenHeart-L mailing list> > >> > > Send postings to:> > > OpenHeart-L@lists.hsforum.com> > >> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > > http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > > All messages transmitted by the OpenHeart-L are subject to the policies> > > and> > > disclaimers posted at:> > > http://www.hsforum.com/listdisclaim> > > -----------------------------------------> > >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L@lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L@lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> ----------------------------------------- > _________________________________________________________________ > Free games, great prizes - get gaming at Gamesbox. > http://www.searchgamesbox.com_______________________________________________ > > > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From msfirst at gmail.com Sun Mar 2 10:14:52 2008 From: msfirst at gmail.com (Michael Firstenberg) Date: Sun Mar 2 10:15:23 2008 Subject: [HSF] Image of the week - Trans toric approach to the aortic valve In-Reply-To: <89c4ed2d0803020516i1cc8a698m21407982567df352@mail.gmail.com> References: <89c4ed2d0802290541p7c57bf4ase238d4c448e0e26c@mail.gmail.com> <89c4ed2d0802291627k780a7d6cm507f4124e053a67c@mail.gmail.com> <89c4ed2d0803020110o35ce3bbeha1771bdf3e6b16c0@mail.gmail.com> <89c4ed2d0803020516i1cc8a698m21407982567df352@mail.gmail.com> Message-ID: Hal - How do you size them, clearly I do not use as many as you, but the ones I do put in are in patients with huge annulus (4-6cm) and I am afraid of downsizing too much. I am afraid of the ring tearing thru the tissue and more importantly we have a very senior (and smart) heart failure/transplant cardiologist here who thinks we create tricuspid stenosis but downsizing to much (he in fact would prefer that we leave the t-valve alone altogether) -michael On 3/2/08, Prasanna Simha M wrote: > > I do agree that these sizes are gigantic and I have rarely used such > large sizes. I use the former sizer to cover the ATL (the same sizes > that you can see in the JPEG that I sent earlier)and use that size. In > the cases where I have used such a big ring the RV and Tricuspid > annulus were huge. In fact the septal area extended 4 cms from the > ends of the sizer. As I said the RV was so huge that probably I could > swim in it and I am not sure if I could reliably cram the ring inside. > I have got No TR in the case with a good coaptation line on Control > Echo done both on table and 24 hours later. In fact I used to not make > and keep size 40 and 42 earlier but after having to make one in a > hurry in the past I have kept them ready just in case and I have used > them occasionaly .