[HSF] small mitral valve

[Nasser F. Abou'Seada]

Dear Erez 
I share the same opinion as Homayoun, thinking that the annulus will yield
itself to a bigger sized prosthesis once well debrided of all foreign
materials, albeit anecdotal. 
inserting a tilted prosthesis "as per Hal" would do the trick in such case
with insertion of a decent sized prosthesis. 

In my training, I've assisted in many TOP-HAT procedures .... seems a logic
solution for such a small annulus .... no recent personal experience with
the procedure. 

I also concur with the point that should the annulus be enlarged, the only
way is through the aortic curtain into aortic "annulus" ... having a double
valve replacement then. the choice would be between a double valve
replacement and a bad haemodynamic mitral prosthesis. what is the risk of
adding an aortic prosthesis to a mitral prosthesis !!

Incidentally, .. what was the functional diagnosis? .. why was the valve
replaced ? condition of the patient ? 

Good luck with your tough case. 


NFA

> From: Homayoun Jalali
> Dear Erez,
> This lady's annulus has to be 18 as she has an 18 mm mechanical
> prosthesis in place since age of 11. I am quite sure that when you will
> remove the previous prosthesis you will be able to fit a much larger
> one. In my experience the annulus is held by the prosthesis and once you
> take out all the foreign materials it will let itself go larger. I
> believe this is a patient with congenital mitral valve disease and not a
> rheumatic (where things can be very different the 4th time). If you
> really have to enlarge the annulus I would go for it from the aortic
> view but will leave the native aortic valve alone.
> 
> Good luck,
> 
> Homayoun Jalali
> 
> 
> >>> erezsharoni at gmail.com 29/12/2006 5:50:31 am >>>
> Dear members,
> I Wonder if any of you have an experience dealing with small MV
> annulus:
> 22y/o female: Past history of:
> MVR: 1 y/o, 6 y/o and 11 y/o last one 18mm . Now she 22 y/o needs  MVR
> : her
> annulus is tight 18mm . dose any one have an experience of enlarging
> the MV
> annulus? how? results?
> Thanks in Advance and Happy Holidays to you all
> Erez Sharoni MD
> Israel