AW: [HSF] Re: [ccm-l] Image of the week Hemisternotomy

[Dr. Roberto Battellini]

Prasanna,
Congrats, but I think it is not possible without T or L cut in our big old
patients with calcified sternum.
Roberto

-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Prasanna Simha
M
Gesendet: Mittwoch, 30. April 2008 17:51
An: gabi ford
Cc: OpenHeart-L; <ccm-l at ccm-l.org>
Betreff: [HSF] Re: [ccm-l] Image of the week Hemisternotomy

Gabi,
This is a view of the mitral valve during a hemisternotomy. I do not think
that the view is compromised. You can clearly see the subvalvar (I am doing
a combined chordoplasty (chordal shortening +neochordal construction ) of
the AML chordae.
Prasanna
On Wed, Apr 30, 2008 at 10:13 PM, Prasanna Simha M <prasannasimha at gmail.com>
wrote:

> I do not think I am compromising on any step of the operation. I am doing
> routine operations through this approach without changing any aspect -
> central cannulation routine instrumentations etc and a smaller incision is
> just an addon.They also seem to have less blood loss.Why would I do it in
an
> oldie - preservation of the manubrial continuity seems to help in postop
> recovery, breathing etc.If nothing a smaller scar is always welcome !! I
> will not hesitate to convert to a full sternotomy if required. My new
> lecturer was worried when I was doing a double valve replacement + TV
repair
> in a patient(He was seeing it being done for the first time). He was
> convinced after I showed him that there was no compromise in exposure. If
> you see carefully the upper part of the sternotomy actually exposes the
> suprasternal notch , innominate vein etc and the actual cannulation site
is
> not that high in most cases.
>
> Prasanna
>
>
> On Wed, Apr 30, 2008 at 10:01 PM, gabi ford <gabiford at hotmail.com> wrote:
>
> >
> >  From: prasannasimha at gmail.com
> > > Havent got any exiting photos from some time so posting a postop
> > photo. Mitral valve repair done in a 20 year old patient via a
> > hemisternotomy at his 6 month follow up.Not as small as the robots but
> > getting somewhere there :). Patient is very happy with the cosmesis
despite
> > a hypertrophied scar as the scar is not seen even when his second shirt
> > button is left open.
> >
> > Prasanna,
> >
> > Only small evidence of the battle!  :)
> > Can you do better work with a bigger opening?  What I'm getting at
> > is the question
> > of compromise in technique, etc. with a smaller field?
> > Do you care how small the opening/scar is when the patient is old and
> > presumably cares little about the size of a scar?
> >
> > Gabi, RN
>
>
>
>
> --
> Prasanna Simha M




-- 
Prasanna Simha M