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Most normal. viagra safe conception The base of the septal leaflet of the tv anchored multiple pledgeted sutures to support the vsd patch. viagra canada online An anomalous persistent right superior vena cava draining to an unroofed coronary sinus was ligated. The unroofed coronary sinus was repaired by reseptation of the atrium with a bovine pericardial patch. Postoperatively the patient continued to have congestive heart failure. viagra online without prescription He was managed medically and discharged, but was readmitted in 3 months' time with worsening right-sided heart failure, severe liver congestion, and ascites requiring ventilatory support. pics of viagra pills The clinical and echocardiographic evaluation showed a residual vsd and severe tv stenosis (mean doppler gradient, 10 mm), small tv annulus (1. 2 cm; z value of <-3 standard deviations for body surface area) as compared with a mitral valve annulus of 2. 3 cm. At operation, the tv was severely stenotic with a small annulus. There was severe fibrotic reaction at the area of the septal leaflet where the pledgets had been placed at the first operation, contributing to the valve stenosis. The bovine pericardial patch, although it showed no shrinkage, was taken down and all the pledgets were removed and the valve was dilated. The vsd was reclosed with another patch that was sutured with continuous suture without pledgets. Despite this the valve remained stenotic. With manipulation and attempts at repair, the valve also became incompetent. All attempts at repairing the valve failed. viagra cost The tv was then closed completely with a bovine pericardial patch. The ra was connected to the rv using an extracardiac fresh antibiotic-preserved size 22 aortic homograft, which was placed in an inverted position to be in the direction of the circulation (fig 1 ). viagra safe conception The ventricular end of the homograft was sewn to the right atrium directly with 5-0 prolene (ethicon, somerville, nj) suture. cheap viagra Because it was an aortic homograft there was enough length and natural curvature to reach the rv with a proper gentle alignment. viagra 5mg or 20mg A longitudinal ventriculotomy was made in the rv outflow tract below the pulmonary valve annulus. buy viagra online usa no prescription The distal end of the homograft was cut obliquely and anastomosed directly to the rv with 5-0 prolene suture. View larger version (71k): [in this window] [in a new window]   fig 1. Schematic representation of the aortic homograft between right atrium and right ventricle.   the patient came off pump without difficulty. Hemodynamic data obtained from cardiac catheterization postoperatively demonstrated no diastolic gradient across the homograft functioning as a tv. The ra pressure was 10/15 mm hg (mean, 10 mm hg); rv, 41/3 mm hg (mean, 9 mm hg); and pulmonary arter. buy viagra without prescription ©2008 Megan Hudlow Designs. All Rights Reserved.