[HSF] RE: MVR with a difference

[A]

Prasanna:
Thank you for the quick response. Sorry no images are available. The
cardiologists refused intervention the mitral. It seems that I am stuck

Ahmed

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of psimha
Sent: Wednesday, August 08, 2007 5:22 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] RE: MVR with a difference

Ahmed,
If there is calcification, think twice before repair. Can you send me 
some echo frames of PLAX/SAX and 4C ?
In a small lady you can implant a 25 mm valve. Excise the valve (I have 
shown a figure of a case done recently with a clot) and debride. 
Construct artificial chordae (I use Ticron sutures for these in 
prosthetic MVR).  Then based on what you can size  a 25 mm valve may be 
what you have to work with !!
There are articles about mitral prosthetic mismatch recently but in a 
rail lady with a buttery heart be hesitant to squash down a large 
prosthesis.
Incidentally if you were planning to conserve the valve in the lady why 
not do a high risk balloon with OR standby. If there is no commissural 
calcification the valve may open and you may give the old lady a few 
years and that too free from a knife.
If you have the EOA then the value that doesn't cause patient prosthetic 
mismatch (at least from the article) is 1.2 cm2/m2 I bet it will be more 
than that in a41 kg fragile lady.
Prasanna
A wrote:
>  _____  
>
> From: A [mailto:alsadd at ksu.edu.sa] 
> Sent: Wednesday, August 08, 2007 3:08 PM
> To: 'OpenHeart-L at lists.hsforum.com'
> Subject: MVR with a difference
>
>  
>
> Dear forum members:
>
> A fragile 85-year old female weighs 41Kg has severe MS. Echo reveals heavy
> calcification of the valve MVA is < 0.75
>
> Coronaries are clean no other co-morbid conditions. Planning surgery with
> the hope of repair but the cardiologists are warning me that the valve is
> densely calcified LA rather small. I have  a feeling that a size 27 would
be
> difficult to use in her case. 
>
>  
>
> In the event of failure of repair and we had to replace, given her
> fragility, weight and the small LA  what do you recommend tissue or a
> mechanical valve ? The other question would any one of the members use a
> size 25 in the mitral?
>
>  In either categories of the prosthetic valves.
>
> Thank you for your opinion.
>
>  
>
> My apologies I forgot to sign my name I am re-sending it. Please excuse
the
> error
>
>  
>
> Ahmed
>
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