[HSF] RE: MVR with a difference

[A]

Hal:
Sorry I have trouble with my computer Please excuse the poorly written
message

Ahmed

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Hgrmd at aol.com
Sent: Tuesday, August 14, 2007 3:31 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] RE: MVR with a difference

Ahmed,
  As long as the patient was in a sinus rhythm (if AF, do a maze), why
would 
anyone give you flak about implanting a porcine valve in the mitral
position 
for an 85 yo patient?  My only difference would be valve  choice.  I would 
have used a SJM Biocor because of its relatively low  profile (9mm for
Biocor 
versus 13 mm for CE porcine).  This can be  very important in preventing
LVOT 
obstruction in a small hyperdynamic heart,  which I suspect your patient
would 
have.  Did you measure the gradient  across the LVOT after implanting the
valve?
  The only time I would use a mechanical valve in such a situation  would be

a small, heavily calcified annulus that wouldn't permit a 25 mm tissue
valve. 
 In that case, I would use an ATS AP mechanical.  This mitral  mechanical 
prosthesis sits on top of the annulus.  For the heavily  calcified areas, I 
simply suture the sewing ring to the LA.  I've done it  probably 3 or 4
times with 
good results.  It can definitely get you out of  a jam.
 
Hal 



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