[HSF] Indications for maze with mitral surgery

[Prasanna Simha M]

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,  <Hgrmd at aol.com> 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
>
>
>
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-- 
Prasanna Simha M