[HSF] small Mitral valve

[Salerno, Tomas]

Batista did mitral valve repair and replacement via the left ventricle,
after performing left ventriculectomy.  MVR is simple if there is no AI,
and mitral repair was via Alfieri's repair.

Tomas

-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of
prasannasimha
Sent: Monday, January 01, 2007 11:07 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] small Mitral valve

It is pretty straight forward doing it through an anterior aneurysm. It 
is OK for an MVR and a posterior annuloplasty and probably an Alfieri.
but frankly nothing like going the conventional way.
If you are doing an MVR sutures are placed in the reverse way.
Prasanna
Michael Firstenberg wrote:
> During training, I always asked about doing mitral valve work thru the

> LV - but never saw one or got a good answer.  How do you do it?
>
>
> -michael
>
>
>
> On Dec 30, 2006, at 2:11 PM, Hgrmd at aol.com wrote:
>
>> Dear Bob,
>>   It may be easy to do a mitral repair via a left ventriculotomy 
>> while  doing
>> a Dor.  However, assuming you are talking about a Devega, it is the  
>> wrong
>> operation for this type of pathology.  MR due to annular dilatation  
>> should be
>> treated by a full rigid, or semirigid ring.  It's been amply  
>> demonstrated that
>> flexible, posterior repairs do nothing to decrease the
septal-lateral
>> dimension or to prevent further anterior annular  dilatation.  To me,

>> the time
>> required to open and close a left atriotomy is  well worth taking so 
>> that a proper
>> procedure can be carried out.
>>   As long as procedures can be carried out expeditiously, and as 
>> long  as
>> proper attention to myocardial preservation is observed, I try to do 
>> each
>> procedure as best as it can be done.  Avoid shortcuts.  An  
>> illustration is the case
>> I did yesterday.  The 64 yo man was Class IV from  severe MR and 
>> mod-severe
>> TR.  The coronaries were normal and the EF was  50%.  He also had 
>> PAF.  The TEE
>> showed a flail posterior leaflet with  normal leaflet thickness.  
>> Intraop, it
>> looked like fibroelastic deficiency,  definitely not Barlowe's.  I
>> resuspended P2 with 4 Goretex neochords and  installed a Physio.  I 
>> also did a Cryomaze
>> and repaired the tricuspid valve  with an MC3.  Coming off, there was

>> mild MR
>> with good hemodynamics.  I  looked at the short axis view and noticed

>> that the
>> jet was towards the posterior  commissure.  It also appeared that the
>> posterior leaflet was mildly  tethered.  Obviously, I had made one 
>> set of chords a
>> little too  short.  I guarantee that a lot or most surgeons would 
>> have left the
>> mild MR  since the patient looked so good.  However, I went back on
and
>> replaced the  set of chords in the posterior papillary muscle.  I 
>> also did a
>> posteromedial commissuroplasty with the "magic" stitch.  Additional 
>> clamp  time was
>> exactly 30 minutes.  The postop TEE was now perfect with zero  MR.  
>> The depth
>> of closure was 15 mm.  I felt much better, and the  patient was fine 
>> this AM.
>> Would he have done as well with the first  attempt at repair?  
>> Probably, in
>> the short term, but data shows even mild  MR adversely affects the 10

>> year
>> survival.
>> Happy New Year to you and yours,
>> Hal
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