[HSF] 25 mm valve

[Ani Anyanwu]

Prasanna,
 
We do not have the same young rheumatic population that you see. Most of our replacements are elderly women, not infrequently reoperations, with small ventricles. We have discussed in the past that we (like Hal and others) had two ventricular ruptures from placing the perimount valve in these patients. There is usually no perceived desire (by surgeon) or need to get in a valve bigger than a 25mm. I am not sure if there is really much difference between a 25mm and 27mm and I doubt the difference comes into play in the elderly patient. Valve replacements in young patients sometimes occurs but is uncommon. We did actually have a 23 year old Indian lady we placed a 25mm porcine valve last week and we actually did have to split the PML else it would not even accommodate the 25 mm sizer.
 
I note you stress the importance of ventriculo-annular continuity. You may not be aware but recent data from Tirone David's group (in press) does not show any difference in long-term outcomes between chordal sparing an non-chordal sparing valve replacements. He does not give explanations why but reports this a a surprise finding. The world goes round in circles.
 
Ani



> Date: Thu, 16 Aug 2007 21:47:34 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] 25 mm valve> > 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> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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