[HSF] Rheumatic mitral valve

[rwmfglycar at aol.com]

Whether or not to do a commissurotomy for mitral stenosis by any method is entirely pathology dependent. Whether done by balloon, a metallic dilator, trans apically or transseptallym, with or without cardiopulmonary bypass,?the result depends on the pathologic stage of the rheumatic disease. In the early days of closed commissutotomy we learned quite quickly which cases were not suitable for commissurotomy alone.?Since the pathology is progressive the older a patient is the less likely it is thet a commissurotomy will do the job. To attempt a commissurotomy by balloon ?when the pathology is unsuitable does the patient no good and may do harm.?To offer?a balloon in a case unsuitable for commissurotomy?because it ?does not involve a?thoracic incision? is simply stupid.
Bob
PS? I was at a wonderful family wedding on a sheep farm in Somerset, England. In 4 days there were 384 E mails most with HSF labels.
For some of you who may not know, Bob Emery had a serious motorcycle accident riding to the hospital and is now being treated for multiplr fractures.


-----Original Message-----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 28 Jun 2007 10.18pm
Subject: Re: [HSF] Rheumatic mitral valve



Sorry Ed I had not read this when sent previous mail.

Why don't they offer valvuloplasty? Is it a disbelief in the efficacy of the 
procedure or a lack of skill to do it?

>From the ethical view point, it could be argued that valvuloplasty should be 
discussed with the patient and the choice given to go elsewhere if the patient 
chooses percutaneous over surgery? Assuming this patient were 10 years older 
would you still operate or first seek a percutaneous option?  


Ani

----- Original Message -----
From: ebender001 at charter.net
Sent: Wednesday, June 27, 2007 10:11 AM
To: OpenHeart-L at lists.hsforum.com
Subject: RE: [HSF] Rheumatic mitral valve

Ahmed:
LA size is 3.5 cm.
Normal coronaries.
Our cardiologists do not do balloon valvuloplasty.

Ed Bender, MD

---- A <alsadd at ksu.edu.sa> wrote:  
> Dear Ed:
> What is the LA size any TR? Coronaries clean? With pure MS no regurgitation
> a commisurotomy is all what you probably need to do.  
> Just wondering if the coronaries are clean and no evidence of clots our
> cardiologists would not refer such patients to surgery they will try
> percutaneous valvotomy. Wish you luck I am sure that she would do fine in
> your hands.
>  
> Ahmed
>  
>  
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Edward Bender
> Sent: Tuesday, June 26, 2007 8:28 PM
> To: OpenHeart-L
> Subject: [HSF] Rheumatic mitral valve
>  
> I have a 70 year old female with paroxysmal a-fib and mitral stenosis   
> from rheumatic fever as a child.  I plan a maze procedure and mitral   
> repair.  By TEE I am convinced that she can be treated with mitral   
> commisurotomies.  She has very little calcification and no   
> regurgitation at all.  The patient has class 2 symptoms and good LV   
> function, but she is really bothered by the repeated bouts of a-fib.    
> My question is whether, upon repairing the valve, she should have a   
> ring to support her annulus.  We rarely get to do these procedures in   
> the USA, so I wonder what the current thinking is.
>  
> Ed Bender, MD
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