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Correspondence

Reply

Department of Cardiothoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090 Austria

(Email: martin.czerny{at}meduniwien.ac.at).

To the Editor:

We thank Dr Elsayed [1] for his supportive comments regarding our article [2]. Our colleague disagrees that the incidence of obstruction of the Top Hat prosthesis is similar to other mechanical valves. So do we. As a consequence we have been stating that the incidence of obstruction is presumably not higher, as in any other mechanical valve type. Due to the low numbers in this series, we remained with this attenuated statement.

Furthermore, we agree with our colleague that choosing the correct valve size is vital, but this should be a self-explanatory issue in academic cardiac surgery. Also, reconfirmation of unaffected anatomy of the ostia after tying down the stitches should be a basic requirement. Finally, tying the stitches within the left coronary sinus followed by the right and noncoronary sinus should be a very basic cardiac surgical technique in each institution.

Nevertheless, as has been extensively discussed in our article, the interaction of this very prosthesis with a small aortic root may be by far more complex, and different loading conditions may be unpredictable immediately after weaning from the pump. Our colleague also advocates the selective use of transesophageal echocardiography. We would go further and strongly recommend the routine use of transesophageal echocardiography in every open-heart procedure to be able to detect and act and not to wait until reaction is the only means available.

	References

Top References

 

1. Elsayed H. Predicting complications of Top Hat prosthesis in aortic valve replacements: suspicion can save lives Ann Thorac Surg 2009;87:676-677(letter).[Free Full Text]
2. Roedler S, Czerny M, Neuhauser J, et al. Mechanical aortic valve prostheses in the small aortic root: top hat versus standard carbomedics aortic valve Ann Thorac Surg 2008;86:64-70.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Martin Czerny Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Czerny, M. Articles by Roedler, S. Search for Related Content PubMed PubMed Citation Articles by Czerny, M. Articles by Roedler, S. Related Collections Related Article