[HSF] Large ASD in a 21yo

Nasser F Abou'Seada nfaabouseada at gmail.com
Tue Dec 1 02:00:07 EST 2009 

Dear Homayoun 
I believe You are quiet right 
To my mind, a surgeon in the intersection / inter-domain of
Congenital-paediatric & Valve repair "simulating a Venn Diagrams status" 
One problem . !! 
Surgeon's Ego !! ...refusal to see reality !

NFA


-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Homayoun Jalali
Sent: Tuesday, December 01, 2009 1:44 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Large ASD in a 21yo

Tea,
 
In our environment if an experienced mitral valve surgeon got a case like
this he would likely ask another experienced mitral valve surgeon with
congenital experience to give him a hand. A non experienced mitral valve
surgeon would simply refer this patient to the second surgeon.
 
AV canal type valves in adults can be (not always) a real challenge and
their numbers are small in anyone's practice.
Here I am expressing my personal opinion: a patient like this may not get
the best outcome from a surgeon who does not have congenital experience.
Quite equally a patient like this will not get best outcome from a surgeon
experienced in congenital heart disease but not expert in valve repair. If I
had to choose between the two options I would refer him to a valve repair
surgeon as opposed to the congenital surgeon.
 
Confusing perhaps?
 
Homayoun Jalali
 

>>> Tea Acuff <tacuff at swbell.net> 01/12/2009 2:39 pm >>>
Just to stir the pot a little since mitral competence is one of our favorite
topics, I mean competence of the mitral surgeon not the valve itself. Who is
"competent" to repair congential valves? Who does more than the similar
handful of (any) mitrals that I do a year? It would seem the the "rules"
would change for repair of congentially defective valves (what C. Class is
that?) even if the underlying mechanisms for function must be met.

Tea

   

Sent from my iPhone

On Nov 30, 2009, at 9:03 PM, Rwmfglycar at aol.com wrote:

1) Define precisely the mechanism of incompetence of the mitral and  
tricuspid valves and if the leaflets are not diseased the mechanism of
their 
failed coaptation.
2) How large are the ventricles? How well is the LV contracting?
3) I would not leave the mitral and  tricuspid insufficiency 
3) He should be able to tolerate  valve repairs and ASD closure but  the 
hypokinetic RV is worrying. I have seen these persist.
Bob



In a message dated 12/1/2009 1:18:53 A.M. South Africa Standard Time,  
drmitch at cox.net writes:

I was  referred a 21yo "developmentally challenged" young man with 
progressive  shortness of breath and an ASD. Mental status reminds me of an 
autistic,  up and about with his mom. Answers questions with a nod or one 
word,  etc.
TEE shows a large secundum defect, severe MR and TR. The RV is  hypokinetic.
Cath findings: Qp/Qs= 6.5
PVR  2.53 Wood u
SVR 10 Wood u
CO 5.4
PAP 35/29/32
PCW18

I plan on  patching the defect, but I'm curious as to what the HSF 
pediatric  
brain-trust might suggest for the MR and  TR. Ring them both? Leave  it 
alone and let the heart regress back to normal (doubt)? Thanks in  advance.

Mitch

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