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

[Prasanna Simha M]

It may not occur in dilated ventricles but can be a real issue in
patients with rheumatic TR especially TS TR. I do worry if I will
create TS in those situations.
Prasanna

On Sun, Mar 2, 2008 at 9:07 PM,  <Hgrmd at aol.com> wrote:
> Michael,
>   I've never ever seen tricuspid stenosis on a postop echo.  I  suspect the
>  tricuspid is much like the mitral.  Patient size mismatch is  generally not an
>  issue.  Don't feel alone about your program's relative  neglect of the
>  tricuspid.  I was shocked to see that Chitwood's program had  a concomitant tricuspid
>  repair rate of less than 5%.  It is a fact that  even moderate TR, like MR,
>  adversely affects the 10 year survival.  If you  do it warm, beating heart
>  after the clamp is released, there is virtually no  down side to repairing TR
>  other than the cost of the prosthesis.  As I've  said many times before, going
>  back in and fixing newly developed TR has enabled  me to wean patients from the
>  pump without a balloon.  I'm convinced I've  avoided more than a few bad
>  outcomes by my current policy.
>   I size them by placing the sizer over the unfurled anterior  leaflet.
>  Generally I will undersize by 1 to 2.  If you think about  it, particularly in
>  secondary MR cases from myopathic ventricles, why should  only the left AV valve
>  dilate?  Those cases, in particular, deserve a ring  if the systolic diameter
>  is 40 mm or more, regardless of the amount of current  TR.  Also, any case
>  with a preop echo showing moderate or worse TR need to  be repaired, regardless
>  of the intraop findings.  I'm sure our good friend,  Dr. Frater, would agree.
>
>
>  Hal
>
>
>
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-- 
Prasanna Simha M