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Patient with Protein C&S deficiencies, h/o multiple PE's, progressive and severe AI with dilated and impaired LV. Required SAVR, mini incision. Path pending, but probable organized thrombus under each cusp. Kim de la Cruz, MD FACS FACC FCCP Aorta guy Aspiring CT Surgeons Michel Pompeu Sá

Watching Paris Olympics has me reflecting on success vs mastery. Success is hitting that goal(an event), but mastery is knowing that it means nothing if you can't repeat it over & over again. It's not a commitment to a specific goal but instead to a constant pursuit. Thoughts?

Undersizing a mitral valve with a small ring is a bad idea, & "nature" (heart contracting >100,000x/day) will win... I am witnessing more dehissed rings requiring re-operations for recurrent MR. Rethink how to size the mitral valve orifice. Ovidio García Michel Pompeu Sá

Thank you Marc Moon & Joseph Coselli, MD for putting together a fantastic Aortic program in Houston! I was able to share thoughts on root enlargement, & feel strongly that every surgeon who replaces the aortic valve should be able to safely enlarge the root to avoid PPM.

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Down-sizing a mitral with a small rigid ring is invites dehissence of prosthesis from annulus. Nature's physiology will win. 76 yo s/p MV repair 7 years ago. Required valve replacement for severe MR with 33mm Epic valve. Michel Pompeu Sá Tom C. Nguyen, MD Aspiring CT Surgeons StanfordCVFellowship

Another improperly harvested LIMA done years ago in a man who needs redo CABG. STS risk calc does not account for grafts stuck to chest wall. The 2 proximal clips on LIMA do not move. Graft is pushed medially. Beware. Now at high risk for injury. 🤬Aspiring CT Surgeons The Society of Thoracic Surgeons

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Constructed St Jude Regent valve with Hemashield tube conduit to create a 1 cm proximal cuff, creating space above underlying St Jude mechanical heart valve... read previous post. 3rd time reoperation today ...Stephen Spindel MD Aorta guy Tom C. Nguyen, MD Aspiring CT Surgeons Stanford Cardiothoracic Surgery

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A classic rheumatic" fish-mouthed " aortic valve excised this AM. 50-year-old man with 2 prior mitral valve operations, the last one 20 years ago with a mechanical heart valve. Aortic valve replaced with a 23 St Jude Regent valve.