[HSF] Image of the week - Trans toric approach to the aortic valve

Sun Mar 2 21:43:35 EST 2008

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 <prasannasimha at gmail.com> 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
> <benjamin.bidstrup at bigpond.com> 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)
> >  >_______________________________________________
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> >
> >  --
> >  Ben Bidstrup FRACS FRCSEd FEBCTS
> >  Consultant Cardiothoracic Surgeon
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>
> --
> Prasanna Simha M
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