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

Sun Mar 2 19:03:36 EST 2008

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 <anianyanwu at hotmail.com> 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 at gmail.com> To: OpenHeart-L at 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 <nkkejriwal at gmail.com> 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 <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)> > > > >_______________________________________________> > > > >OpenHeart-L mailing list> > > > >> > > > >Send postings to:> > > > > OpenHeart-L at 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 at 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 at 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 at 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 at 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 at 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