[HSF] Trip to Croatia

[rwmfglycar at aol.com]

Hal
As I said, there is no doubt that the failure to tan the autogenous pericardium was the major cause of the failure, but beware of pericardium with any evidence of inflammation such as adhesions; I saw that become myxomatous once. Be aware also of elongated anterior chordae in rheumatic disease and general stiffness even of unshrunken tissue. If you have to work hard to get flexibility of the rheumatic tissue you may already be dealing with a quite advanced rheumati process.
 Try "Anatomical Rules for Plastic Repair of the Diseased  Mitral Valve. Frater, Thorax, 1964:19:458". This was the description of the technique. By the time I had enough cases to start talking about durability of repair, I had to report the basic failure of the autogenous pericardium (at the 2nd meeting on artificial heart valves in Century City , 1969). I have a bias in favor of factory produced properly treated xenograft pericardium because it is possible to control the selection of the material. (Since I actually make the stuff I have also a serious conflict of interest)
Bob
 
 
-----Original Message-----
From: Hgrmd at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Sat, 7 Apr 2007 4:20 PM
Subject: Re: [HSF] Trip to Croatia


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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