[HSF] Image of the week - Failed repair

[Ani Anyanwu]

Prasanna
 
I am wondering how the discussion went straight to mechanical MVR without consideration for rerepair? On balance of probability this would not be her last operation even with mechanical valve. Assuming the preop discussion had not decided on mechanical valve, would your instinct have been to repair again or to replace? What size valve did you use?
 
PS - I see you are opening the RA in redo without caval control by tapes or balloons - I remember a year ago you were one of those who crucified me when I said caval snaring was not necessary, and I rarely employed it for tricuspid valve surgery, provided one uses vacuum assist. Doing these redos without caval control removes an unnnecessary level of complexity and does not compromise exposure.
 
Ani
 
 



> Date: Wed, 5 Mar 2008 20:08:35 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at hsforum.com> CC: > Subject: [HSF] Image of the week - Failed repair> > 14 Year old girl (currently) operated 2 years back for a repair with> eMaze with good result. 1 1/2 years later Had a bout of rheumatic> fever with progressive MR. I had to go in again in view of increasing> MR. We discussed with the parents who opted for a mechanical MVR this> time.In sinus rhythm> Findings Bilateral combined chordoplasty was intact with AML level at> expected height. The trenchless chordoplasty site was well preserved> and the chords of the AMl and leaflet were well preserved. There was a> tear of the glutaraldehyde treated pericardium which had given rise to> annular dilatation with that being the mechanism for failure of the> repair. It would have been probably good for a ring placement but the> discussion preop was ultimately for a replacement even if rerepairable> so I replaced the valve.> Femorals cannulated (but I did not go on bypass but did open the> sternum as the sternum appeared easy to open. Minimal dissection and> entered both pleurae. Dissected enough aorta for cardioplegia and> cross clamping.SVC cannulated through intact pleura . RA opened> without taping (vacuum assist) and trans interatrial MVR. Total blood> loss post op 110 ml.> Lessons learnt ?> Pericardium can dehisce. Does rheumatic fever and inflammation have> been contributary since Echoes done till 1 1/2 years after surgery (I> get echoes every 6 months for all cases) were good.> > -- > 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> -----------------------------------------
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