[HSF] small mitral valve

[Peter Pohlner]

Dear Erez,
 Need to gauge the required valve size on her surface area and
projected cardiac output.Also need some info on cuurent pulmonary artery
pressures.
Example; 22yo   Probably 1.6- 1.8 Metre square BSA.     ? PAP ~ 80
mmHg.
     She will require minimum 25mm mitral valve to achieve a post op
mean gradient of 3-7mm Hg at rest, 7-12 with exercise, her PAP may
decline but this cannot be guaranteed. Should have NO and Sildenafil
available post op, with Cardiac Output monitoring to gauge their
effects.  PHT may pose the most significant risk postop.
Regarding the mitral annulus, I would agree with my colleague DrJalali,
that comprehensive removal of the current prosthetic device and the
adjacent fibrous tissue will allow a valve of at least 25mm to be
accommodated. Having had the experience of upgrading valve sizes in this
group of congenital valve disease patients, without any mortality to
date, it should be noted that the tissues are usually of excellent
quality, expandable when the fibrous tissue is removed, with minimal
risk of annular rupture when compared to more elderly female patients.
It may be worth defining her coronary anatomy preop , to give you
confidence about the depth of suturing you can employ during MVR.
Hope this helps,            
best wishes and good luck.          
                                           Peter Pohlner.
                                                              TPCH.
Brisbane. Australia.

>>> erezsharoni at gmail.com 12/29/06 5:50 am >>>
Dear members,
I Wonder if any of you have an experience dealing with small MV
annulus:
22y/o female: Past history of:
MVR: 1 y/o, 6 y/o and 11 y/o last one 18mm . Now she 22 y/o needs  MVR
: her
annulus is tight 18mm . dose any one have an experience of enlarging
the MV
annulus? how? results?
Thanks in Advance and Happy Holidays to you all
Erez Sharoni MD
Israel
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