[HSF] Posterior neochordae

[Nasser F. Abou'Seada]

I do the same Prasanna 
LA Penicillin 1.2 mega unit q 2 weeks in winter time & q 3 weeks in summer
time
I concur with your concepts about the use of antibiotics, whether proven
rheumatic cases or not. no place for mishaps, also a small price for a good
prevention.

NFA

> -----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 15, 2007 3:48 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Posterior neochordae
> 
> I was always curious about this fibroelastic deficiency thing as I ever
> found it in any pathology book !!
> I have seen the MR jet causing some fibrin deposition that has been
> mistaken for rheumatic thickening.
> I have had 3 cases in the last week all of which were labeled rheumatic
> but I had my doubts.
> Non had commissural fusion (which would have made the diagnosis of
> rheumatic pathology easier) all had thin elongated chordae and leaflets
> were not that thickened (In the conventional rheumatic sense)and only
> thick were the MR jet hit the leaflet and posterior LA. McCallum's
> patch) and one child in fact had bileaflet prolapse (the same case I was
> discussing  posterior neochordae about). All of these have given
> excellent results with repair and I am now confronted with a situation
> of antirheumatic prophylaxis in these young patients.
> Post repair I give them 2 weekly Penicillin (Long acting) instead of 3
> weekly as a study on MIC levels showed lowered values in the 3rd week
> .Patients complain bitterly about these injections but I am giving them
> for two reasons - a mistake and a recurrent bout of rheumatic fever
> would damage the repair and , with patients coming from lower
> socioeconomic strata / overcrowding etc they are at risk for
> streptococcal sore throat anyway. But, I wonder if I am really doing the
> right thing ?
> Prasanna
> 
> Rwmfglycar at aol.com wrote:
> >
> > In a message dated 1/14/2007 10:21:00 P.M. Eastern Standard Time,
> > prasannasimha at gmail.com writes:
> >
> > I have  one more question - how do you differentiate "fibroelastic
> > deficiency"  versus "Barlow's" on table ?
> >
> >
> > The term fibroelastic deficiency was invented by Alain Carpentier.
> > Pathologists will tell you there is no specific pathologic appearance
for this  gross
> > entity and regard it as nonsense.
> > The intraoperative distinction is based on the extent of valvular
pathology.
> > Prototypical "Fibroleastic deficiency" cases will have a posterior
scallop
> > that is prolapsing or flail and definitely thickened and stretched, but
other
> > tissues that really do not seem abnormal.
> > Barlow's cases have virtually the whole valve looking abnormal with
> > everywhere more  tissue than a normal valve producing the multiple
"hooded"
> segments
> > of both anterior and posterior leaflets. The histology of both leaflet
and
> > chordal tissue is abnormal. The physical properties of Barlow's  tissue
are
> > abnormal. So probably are the physical properties of the flail  part of
> > fibroelastic deficiency cases. Unfortunately there are cases which seem
> indeterminate
> > and with longstanding insufficiency the leaflets develop  thickening jet
> > lesions which some people read as rheumatic disease.  Unfortunately some
of the
> > engineering types who have analysed physical  properties have not always
had
> > accurate information on the gross appearance of  the valves from which
they are
> > sent material for testing.
> > Stiffness always seemed to me to be the hallmark of rheumatic tissue
whereas
> > "degenerative" valve tissue retained far more flexibility .
> > Jane Grande Allen  has written on this.
> > Bob
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