[HSF] Subaortic stenosis

[Nasser F. Abou'Seada]

Prasanna 
I find it very dangerous to peel it off the AML .....
I have peeled it before .... yet would not hesitate to use my SCISSORS
especially at line of attachment to AML .....

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Wednesday, January 17, 2007 10:20 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Subaortic stenosis
> 
> I agree that  myomectmy is now an essentiial part of teh procedure and
> itdoes peel away in the rest of the area esp over the area of th
> conduction tissue and mitral valve.
> Prasanna
> ICHFNO at aol.com wrote:
> > We see a fair number of these, and sometimes the fibrous ridge attaches
down
> > onto the anterior mitral leaflet  a significant way and can restrict
proper
> > closing, resulting in mild to moderate MR. If you have a ridge on echo
or  CMR
> > and the gradient is 30, then I would say it is a toss up, if however
there
> > is concomitant MR or any AR it is without question a surgical case.
Regarding
> > long term results, the best results are in patients where a septal
myomectomy
> > is  performed in addtion to ridge removal, there is a 10-15% recurrence
rate
> > when  you do not perform the myomectomy. Be sure you are careful and to
the
> > left of  the nadir of the R coronary cusp when you make your incision
into the
> > membrane,  to stay away from the conduction tissue. Also, these usually
peel out
> > once you  get them started and if you do this the chance for heart block
is
> > essentially  nil.
> >
> > WNovick
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