[HSF] Trip to Croatia

[rwmfglycar at aol.com]

Hal,
Rheumatic pathology was precisely what the ivalon baffle was used for and did not have a good longterm record. Virtually all rheumatic cases coming to surgery already have a fusion of the interscallop clefts of the posterior leaflet. (Prasanna you may recall did present an apparently rheumatic case a year or two ago that seemed an exception to this rule)
There are rare cases of rheumatic mitral insufficiency with an unshrunken, still pliable anterior leaflet without anterior chordal elongation in which correction of the posterior leaflet pathology alone will produce a competent valve. I found that pericardial enlargement of the posterior leaflet worked beautifully to correct the insufficiency in these cases. Since I was using untreated native pericardium and sometimes rheumatically inflamed pericardium late failure occurred within a few years. Today with the ability to produce xenograft pericardium with a minimal inflammatory response and resistance to calcification, there may be a case for reviving these partial repair techniques. The real problem with rheumatic cases is that the pathology is so often well on its way in all the tissues of the valve that a partial solution is not likely to be better than it was in the early 1960's.
As for using it for subannular calcification cases do you mean those with acute insufficiency with ruptured chordae? Do you plan to leave the calcium and suture the device to it, together with replacing the ruptured chordae?
Bob
 
 
-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Sat, 7 Apr 2007 3:25 PM
Subject: Re: [HSF] Trip to Croatia


Bob,
  While he was still in Croatia, Prasanna and I were talking off line  about 
Mitrofast.  He was discussing possible practical uses of Mitrofast,  and I'd 
like to share them with HSF since I think they could turn out to be  apt.  I'm 
in complete agreement that Mitrofast doesn't make much sense if  the posterior 
leaflet is repairable.  Carpentier's techniques and Goretex  should be able 
to reliably repair such leaflets. However, with severe rheumatic  damage or 
perhaps a calcified posterior annulus, perhaps Mitrofast might be  usable and 
better (?) than a replacement.
 
Hal



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