[HSF] 25 mm valve

[Rwmfglycar at aol.com]

In a message dated 8/16/2007 1:23:53 P.M. Eastern Daylight Time,  
prasannasimha at gmail.com writes:

I just  went through our statistics wrt valve implantation and while I do 
have a  high repair rate (and that is primarily in a rheumatic 
population) the  commonest size was 27 , There were only a few 25 and 29 mm.
Incidentally  Ani, while replacing rheumatic valves do you do a posterior 
split of  thePML.along with a commissurtomy. I find this springs open the 
calcific  valve allowing a larger size to be placed with AML PML 
preservation with  either native tissue or neochordae  (depending on the 
anatomy).Many a  time I hae seen valves where people would have said that 
a 25 mm valve  would only fit and I have seen that the posterior split 
allows a larger  size to be implanted.
Prasanna


Dear Prasanna,
In my previous posting I indicated that in the Bronx 27 was our  commonest 
size but that we did not hesitate to use a 25 and had even used a 23.  Frankly 
we attributed this mostly to the stature of our rheumatic patients, but  also 
recognised that most of the patients who were replaced had some  stenosis. 
Rheumatic pure insufficiences clearly have larger annuli so both  genetics of a 
population and pathology have an influence. You are absolutely  right about 
splitting the central scallop. I found it a very useful procedure. I  also used to 
decalcify the posterior leaflet which can be done while preserving  posterior 
annular papillary connection.
Has India seen the development of a bigger sized generation that has been  
seen in the US, Europe, Australia, New Zealand? If rheumatic fever still existed 
 in those countries would the average valve size be different?
Bob
Bob



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