[HSF] Trip to Croatia

[Hgrmd at aol.com]

Bob,
  I've got a rheumatic MR case coming up this month in which I will  try to 
repair the retracted posterior leaflet with gluteraldehyde treated  autologous 
pericardium.  Perhaps the reason your cases of autologous  pericardium failed 
was not using the gluteraldehyde to denature the tissue. I  plan to resect all 
but the leaflet edge with its primary chordal support.   If necessary, I will 
cut chords and replace them with Goretex.  Jim Gammie  and I saw this 
beautifully done by Professor Dionne in Leiden last fall.   I've tried it once 
without success.  In that case, I think I was timid in  resecting stiffened leaflet 
tissue. Perhaps this time it will work.  This  is the same mind set I used 
many years ago when I first started using Goretex  chords.  I did about 6 or 8 
cases before I finally got it to work.
  For the calcified posterior annulus, I hypothesize that Mitrofast  might 
have a role if it was secured to body of the leaflet or the immediately  
adjacent left atrium.  As you and I have discussed in the past, I take a  dim view of 
radical resection of the calcified annulus (particularly in the  elderly) as 
espoused by Carpentier.  It hasn't worked well for me, and I've  heard it 
hasn't worked well for even the "Master" in certain cases.  My  current policy, 
especially for the elderly, is replacement.
 
Hal
 



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