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

[Michael Firstenberg]

We actually do a lot of TV repairs, I am just concerned about the
annulus/ring separation if I have to downsize from a 4.5cm annulus to a 26mm
ring.

On 3/2/08, Hgrmd at aol.com <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
>
>
>
> **************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)
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