[HSF] prophylactic aortic replacement?

[Prasanna Simha M]

I would.
Prasanna

On Mon, Sep 1, 2008 at 10:22 PM, Douville, Chuck <ecdouville at orclinic.com>wrote:

> Ani I did discuss the Ross with him, and frankly shared my limited
> knowledge about the trouble in bicuspid valve pts you mention, as well as
> the trend away from it over the past several years in the USA. I did tell
> him that there are centers of excellence with good Ross results and that I
> would be happy to refer him there.
> What do you tell these adult pts about the fate of the PA homograft at 20
> years and its impact on right ventricular function? How do you follow them
> at NYU to be sure they don't show up in trouble, suddenly? I am impressed by
> the results with the Ross that you and Dr. Raines in particular have noted;
> when I was at the WTSA this past June, the number of surgeons continuing to
> offer the Ross to young adults like this man has dwindled considerably, as
> most forum readers would acknowledge.
>
> An unscientifc poll.....How many forum cardiac surgeons, presenting with
> the clincial scenario outlined here, would opt for a Ross operation?
>
> ________________________________
>
> From: openheart-l-bounces at lists.hsforum.com on behalf of Ani Anyanwu
> Sent: Sun 8/31/2008 6:05 PM
> To: openheart-l at lists.hsforum.com
> Subject: RE: [HSF] prophylactic aortic replacement?
>
>
>
> Well if you did a Ross you would replace the root anyway - has the Ross
> been discussed with the patient? My personal feeling is that the Ross should
> be discussed as an option with all patients below the age of 40. I do the
> same for the rare young patient I see, and we have referred maybe two such
> patients in last year to our local Ross surgeon who then went on with that
> option.
>
> If I were 36 in his situation I would strongly consider a Ross - although
> there was historically some concern about the ross in bicuspid patients,
> most Ross surgeons would not consider it an issue and bicuspid valves
> constitute a significant proportion of their practice.
>
> Ani
>
>
>
> > Date: Sun, 31 Aug 2008 15:35:45 -0700> From: ecdouville at orclinic.com>
> To: OpenHeart-L at hsforum.com> CC: > Subject: [HSF] prophylactic aortic
> replacement?> > A 36 yr old emergency physician I know, has asked me to see
> him for his bicuspid aortic valve with severe Aortic insufficiency. He is an
> asymptomatic athlete; echo was done for the murmur. He has an LVIDD of 61
> mm, slightly enlarged in our institution (upper normal is 57mm). Aortic root
> is normal in size but his (related by blood) uncle had a bicuspid aortic
> valve replaced and died of an aortic dissection 10 years later.> There is a
> paper by Russo et al (Ann Thor Surg 2002;74:s1773-76 that presents a
> longitudinal study of 100 pts with high late incidence of dissection and
> argues for prophylactic replacement, esp if dilated. Subsequently Borger et
> al (JTCVS 2004;128:677-685 argue for prophylactic replacement if the root is
> over 4.5 cm.> > Thoughts about prophylactic root replacement. I argue for
> no, but told him I would consult the forum.> > > thanks chuckdouvillemd>
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-- 
Prasanna Simha M