Debbie
Well-known member
Hi again brad, you posted last week to me about sources of info. for pulmonary valves. Could you give me the sources so I can look them up. Thanks Debbie
Brad, pulmonary valve question
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Debbie,
Hopefully Brad will respond with the information you requested. Both Brad and myself had Ross Procedures. That means they determined that our pulmonary valve was functioning perfectly, therefore replacing the pulmonary valve with a donor homograft pulmonary valve (since my pulmonary valve is now my aortic valve) is the best option. If you are having surgery for a diseased pulmonary valve it is my opinion that if the diseased pulmonary valve is replaced with a homograft pulmonary valve the same disease process my affect a homograft valve quicker than a tissue valve. Lynn has plenty of experience dealing with her son's pulmonary valve disease, and she said that a bovine tissue valve is the choice of most surgeons. That's why I posted this in the other thread:
If your main (or only) problem is with your pulmonary valve I would ask your surgeon which valve is preferred AND WHY. I'm betting that a tissue valve is more resistant to the issues that caused your pulmonary valve to deteriorate and will last longer than a homograft.
Having said that, all I'm basing my opinions on are from researching the Ross Procedure before I underwent surgery and reading A LOT of posts on this site about all kinds of valve problems including pulmonary disease. I think your surgeon can give you a definitive answer. No offense to Brad...but I don't think he has statistics backing up his post for patients with pulmonary specific disease.
Hopefully Brad will respond with the information you requested. Both Brad and myself had Ross Procedures. That means they determined that our pulmonary valve was functioning perfectly, therefore replacing the pulmonary valve with a donor homograft pulmonary valve (since my pulmonary valve is now my aortic valve) is the best option. If you are having surgery for a diseased pulmonary valve it is my opinion that if the diseased pulmonary valve is replaced with a homograft pulmonary valve the same disease process my affect a homograft valve quicker than a tissue valve. Lynn has plenty of experience dealing with her son's pulmonary valve disease, and she said that a bovine tissue valve is the choice of most surgeons. That's why I posted this in the other thread:
If your main (or only) problem is with your pulmonary valve I would ask your surgeon which valve is preferred AND WHY. I'm betting that a tissue valve is more resistant to the issues that caused your pulmonary valve to deteriorate and will last longer than a homograft.
Having said that, all I'm basing my opinions on are from researching the Ross Procedure before I underwent surgery and reading A LOT of posts on this site about all kinds of valve problems including pulmonary disease. I think your surgeon can give you a definitive answer. No offense to Brad...but I don't think he has statistics backing up his post for patients with pulmonary specific disease.
Brad,(ooops meant Bryan) I think your reasoning makes sense.Afew of the studies I've read about pulm replacement for nonross say thing like this. (now I don't know if it works different for just the valve and not also a conduit)
http://www.ncbi.nlm.nih.gov/pubmed/...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
BACKGROUND: Pulmonary homografts (PH) have been the preferred valved conduits for right ventricular outflow tract (RVOT) reconstruction in the US since the mid-1980s. Although PHs have worked well for Ross patients, many PH extracardiac conduits used for congenital heart surgery suffer from degeneration and develop regurgitation and obstruction within months after implantation and require replacement within 4 to 6 years.
IF you do a search on pulm valve replacement non-ross a few article come up. This one is about the Contegra conduit which is a cows juglar, but it is relatively new and I've read some midterm results aren't as good as they hoped. Justin has a conduit that was made in the OR from a section of dacron then the valve (CE bovine)then more dacron. He had the first section of it replaced this year after 2 years, because of scarring/and the sternum smushing it, so they used a newer material that is stronger since his heart is right under his sternum,and some other things to make it bigger in the space allowed, but the valve at far end of the conduit were perfect so they left them. I know a few people that have pig, but I think right now the ones that have the longest record are the bovine.
From what I know,Many/most surgeons don't recomend mechanical in the pulm position because the pressure thru it is lower than the left side so there is a higher chance of clots
http://www.ncbi.nlm.nih.gov/pubmed/...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
BACKGROUND: Pulmonary homografts (PH) have been the preferred valved conduits for right ventricular outflow tract (RVOT) reconstruction in the US since the mid-1980s. Although PHs have worked well for Ross patients, many PH extracardiac conduits used for congenital heart surgery suffer from degeneration and develop regurgitation and obstruction within months after implantation and require replacement within 4 to 6 years.
IF you do a search on pulm valve replacement non-ross a few article come up. This one is about the Contegra conduit which is a cows juglar, but it is relatively new and I've read some midterm results aren't as good as they hoped. Justin has a conduit that was made in the OR from a section of dacron then the valve (CE bovine)then more dacron. He had the first section of it replaced this year after 2 years, because of scarring/and the sternum smushing it, so they used a newer material that is stronger since his heart is right under his sternum,and some other things to make it bigger in the space allowed, but the valve at far end of the conduit were perfect so they left them. I know a few people that have pig, but I think right now the ones that have the longest record are the bovine.
From what I know,Many/most surgeons don't recomend mechanical in the pulm position because the pressure thru it is lower than the left side so there is a higher chance of clots
Bradley White
Well-known member
Hi Debbie,
Bryan is correct. I don't have any studies to back up what I told you other than ones saying that the pulmonary homograft seems to be lasting a long time in RP patients. I was basically stating for you the facts given to me by my mayo clinic surgeon when we were talking about if my pulmonary homograft needed to be replaced. He was saying he would do it with the another PH instead of a bovine or pig valve thinking that it would last longer. And told me about how good the long term results had been in RP patients. I relayed this information to you not thinking about the fact that the best valve for an RP patient might not be the same as the best valve for someone with a congenital defect on the pulmonary valve. I tried to find some literature on the replacing the PV for people with congenital defects but I couldn't find any! I saw that Lyn found a few so hopefully those will be helpful.
I think Bryan mentioned that they are sometimes hesitant to put in mechanical valves in the pulmonary position because of the worry of clot formation. This is what they told me as well. Sorry for any confusion I may have caused and I want to thank Bryan for catching my mistakes. Good luck Debbie. If your surgeon seems to think a pulm tissue valve is the way to go I certainly would not be one too disagree with him. Please keep us updated.
Brad
P.S. sorry I never responded to this same question after you posed it in the previous thread. I wasn't checking the site too thoroughly the last couple of weeks!
Bryan is correct. I don't have any studies to back up what I told you other than ones saying that the pulmonary homograft seems to be lasting a long time in RP patients. I was basically stating for you the facts given to me by my mayo clinic surgeon when we were talking about if my pulmonary homograft needed to be replaced. He was saying he would do it with the another PH instead of a bovine or pig valve thinking that it would last longer. And told me about how good the long term results had been in RP patients. I relayed this information to you not thinking about the fact that the best valve for an RP patient might not be the same as the best valve for someone with a congenital defect on the pulmonary valve. I tried to find some literature on the replacing the PV for people with congenital defects but I couldn't find any! I saw that Lyn found a few so hopefully those will be helpful.
I think Bryan mentioned that they are sometimes hesitant to put in mechanical valves in the pulmonary position because of the worry of clot formation. This is what they told me as well. Sorry for any confusion I may have caused and I want to thank Bryan for catching my mistakes. Good luck Debbie. If your surgeon seems to think a pulm tissue valve is the way to go I certainly would not be one too disagree with him. Please keep us updated.
Brad
P.S. sorry I never responded to this same question after you posed it in the previous thread. I wasn't checking the site too thoroughly the last couple of weeks!
Debbie
Well-known member
pulmonary valve
pulmonary valve
Thank you Lyn, Brad, and Bryan for taking the time to post to me. My surgeon appt. is tomarrow and I'm really looking forward to talking to him about all this information that I have questions about. Thanks again Debbie I'll post tomarrow and tell you what he says.
pulmonary valve
Thank you Lyn, Brad, and Bryan for taking the time to post to me. My surgeon appt. is tomarrow and I'm really looking forward to talking to him about all this information that I have questions about. Thanks again Debbie I'll post tomarrow and tell you what he says.
harleygirl528
Well-known member
HI Debbie,
Good luck with your surgeon appt tomorrow! Sorry I don't have any information to add to your question but I just wanted to let you know that I will be thinking about you and hope that everything thing goes really well! I am sure you will be prepared with a whole list of questions to run by him and be sure and post and let us know what you find out.
Take care!
Good luck with your surgeon appt tomorrow! Sorry I don't have any information to add to your question but I just wanted to let you know that I will be thinking about you and hope that everything thing goes really well! I am sure you will be prepared with a whole list of questions to run by him and be sure and post and let us know what you find out.
Take care!
Debbie
Well-known member
pulmonary valve
pulmonary valve
Lorie, thanks for the post and encourgement!! Debbie
pulmonary valve
Lorie, thanks for the post and encourgement!! Debbie
S
Susan BAV
There is some interesting detail to be gleaned from this thread...
Debbie, I hope all goes well with your travel and consult today; take care. Looking forward to hearing your update.
Debbie, I hope all goes well with your travel and consult today; take care. Looking forward to hearing your update.
