[HSF] small Mitral valve

[Hgrmd at aol.com]

Tomas,
  What followup, if any, was there for Batista's ventricular side  Alfieri 
repairs?  In all series that I've seen, including Alfieri's, this  type of 
repair without an accompanying ring has terrible long term  results.  In Alfieri's 
large series, over 60% had moderate or worse MR at  the end of 2 years.  If I 
had those kinds of results, I wouldn't have a  significant mitral practice.  
Why do a procedure that has no demonstrable  long term track record?  The 
correct approach to this problem is  transatrial insertion of a full rigid or 
semirigid ring.  Flexible bands,  flexible rings, Devegas, and unsupported 
Alfieri's all have poor long term  performance according to what I've read in the 
literature as well as my own  personal experience (Many years ago, I saw Cosgroves 
inserted for pure annular  dilatation fail within a few months).
  If it exists, somebody please show me a reference that demonstrates  the 
long term durability of a mitral repair done via a left  ventriculotomy.
Hal