[HSF] Rt thoracotomy MVR

[Tohru Asai]

Nand and Discussants!

I am interested in this long threads. And I found that this was the problem
of HSF. Why are you guys so eloquent even without seeing Nand's patient and
her CT scan. I don't care about who's repair rate, who's preferred approach
or generalized comments about each approach.

Is Rt. Thoracotomy really a right approach specifically to her by Nand? In
my mind, questions raised. How severe is her pectus? I experienced a case of
pectus for mitral repair a few years ago. Her lower sternal body is
literally 1 cm distance from vertebral body! Pectus is not simply sternal
and caltilage problem, but the whole mediastinum shifted abnormally. In his
case, he also mentioned "pectus was just filled with prosthesis", this means
the view from Rt. Thoracotomy must be quite different and difficult ( not
only far away but sternal body may be in the way!).Therefore, without
watching CT slice, we should not mention which approach is good or bad!

And if Nand is not always do rt. Thoracotomy, I am afraid that the
outcome...We certainly should take his experiences into consideration in
such a case, then we should comment properly.

Another question, which Ani mentioned too. I want to ask, Why did he want to
replace rather than repair the valve?  Nand should answer why he want to
choose replacement. Because of his experience? We all are not sure. If so,
probably he should ask an experienced surgeon to scrub in together, or send
the patient to a surgeon who is good at mitral repair and good at
non-sternotomy approaches ( Lt. and/or rt.). Although I am not sure how
difficult to perform sternotomy for her.

Nand! Forget about asking tips. Please upload CT scan. Then we can discuss
more realistic strategy and tips you want!
-- 
Tohru Asai
Shiga University of Medical Science
Otsu, Japan