[HSF] Rt thoracotomy MVR

[Ani Anyanwu]

>The reason the "side surgeons"  are experienced in this approach is because they did their first case, and then second case >and persisted with it. If you do not do it, you will never get experience. 
 
Nand
 
But a complex case is arguably not the one to gain this experience. How many of the surgeons giving you this advice have actually done a mitral on a prior pectus case through the side? The last pectus case we did (via sternotomy), the entire heart, including the atria aside from the caval attachments, was dislocated into the left hemithorax and the mitral valve was located far away even via sternotomy, and I would not like to think how one would have got to that from the right chest. Obviously, you have all the scans etc so only you can tell the best approach for your patient.
 
Why does the patient need a replacement and not repair? What is the age of the patient?
 
Ani
 
 



> Date: Wed, 12 Mar 2008 15:42:00 +1300> From: nkkejriwal at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Rt thoracotomy MVR> CC: > > Ani> > > > I want to do this through a Rt thoracotomy for 2 reasons> > > > The CT shows that the sternal prosthesis is calcified. I have seen two cases> where we had to remove the metal bar used to repair pectus. We had a hell of> a time. We probably used every orthopaedic instrument. If I plan a median> sternotomy, I have to dissect the prosthesis from the sternum and remove> it. I am not particularly looking forward to do it if I can possibly avoid> it.> > > > The second reason it what Bob already said. The reason the "side surgeons"> are experienced in this approach is because they did their first case, and> then second case and persisted with it. If you do not do it, you will never> get experience.> > > > I have been involved with a few MVRs through a Rt thoracotomy. I found the> exposure excellent even for a repair. I agree with John that de-airing> should not be a problem. I use CO2 for all my valve cases.> > > > Nand> > > On 3/12/08, Ani Anyanwu <anianyanwu at hotmail.com> wrote:> >> > > I have a young lady who underwent pectus repair many years ago. She now>> > needs mitral replacement for severe MR. I am planning to do it through a>> > right thoracotomy.> >> > Nand> >> > Why exactly do you want to do this through a right thoracotomy? Certainly> > there is no indication for a thoracotomy per se as the procedure will be> > easily accomplished via sternotomy. If thoracotomy is not your usual> > approach for mitral surgery, and if it is not the patient requesting a> > thoracotomy, then may be best to stick to the approach you are used to in> > such an unusual case.> >> > Does the patient certainly need a replacement (and why?) - would a> > sternotomy improve her chances of repair or is valve certainly irreparable?> >> > ANi> >> >> >> >> > > Date: Mon, 10 Mar 2008 20:47:10 +1300> From: nkkejriwal at gmail.com> To:> > OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Rt thoracotomy MVR> CC:> > > > Hi> > I have a young lady who underwent pectus repair many years ago.> > She now> needs mitral replacement for severe MR. I am planning to do it> > through a> right thoracotomy. I have not done many of these. The last I did> > was a> gentleman with mitral prosthesis endocarditis last year. In that> > case, I did> not release too many adhesions and did it under fibrillatory> > arrest.> > In this lady I am hoping to cross clamp the aorta. I know some of> > you have a> large experience with MVR through Rt thoracotomy. Any tips?> >> > Nand> _______________________________________________> 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>> > -----------------------------------------> > _________________________________________________________________> > Telly addicts unite!> >> > http://www.searchgamesbox.com/tvtown.shtml_______________________________________________> > 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> -----------------------------------------
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