[HSF] Tricuspid tissue valve dysfunction

[Tea Acuff]

Bob wrote: It is common for hemodynamics of bioprosthetics on the left side to be  
better a month or two after surgery.
  
What does "hemodynamics of bioprosthetics" mean, Bob?
tea

----- Original Message ----
From: "Rwmfglycar at aol.com" <Rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, May 21, 2008 6:26:40 PM
Subject: Re: [HSF] Tricuspid tissue valve dysfunction

How long postop are you?
It is common for hemodynamics of bioprosthetics on the left side to be  
better a month or two after surgery. I cannot say this is so on the right  side.
I can say that the echo EOA's of bioprosthetic valves  commonly do not have 
a linear relationship with their designated size  showing lower EOA's than 
expected in the larger sizes.
I also know that echo measurements on the right side are difficult  because 
of the shape of the ventricle and the poor fit between the circular  valve and 
the natural orifice.
We routinely measured simultaneous upstream and downstream pressures  and 
cardiac outputs in all our tricuspid annuloplasty cases in the 70's and the  
EOA's derived from these numbers would commonly be between 1.5 and 2.0 and very  
rarely more than 2.0.
I doubt that preserving the leaflets is the issue, especially if the area  
under the valve seems open. I can envisage the anterior leaflet being pulled  
across the entry to the RV outflow if it was folded back. The best way to test  
for that would be to float a catheter into the PA and slowly pull it back  
through the ventricle and valve. (This is certainly not indicated at  present).
It is possible, on the left side, for an oversized biological valve with  
bendable struts to have the struts bent inwards towards one another by the  
subvalvular tissues with a consequent reduction in area available for flow. This  
would be difficult to see with the valve you used.
The key issue is the symptomatic response of your patient. If the right  
atrial/jugular pressure is still high after correction of the insufficiency, a  per
sistently sick right ventricle with a high right ventricular pressure can be  
the cause.
For the time being watch and wait.
Bob




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