[HSF] Rheumatic mitral valve

[rwmfglycar at aol.com]

I am picking this up while travelling and have got my Email # down from the high 300's to the high 100's. I shall be brief and dogmatic. Insufficiency is due to failed coaptation
Rheumatic mitral insufficiency in my experience was most often due to 
1) Tissue shrinkage 
2) Anterior leaflet chordal elongation (very rarely in acute cases ruptured ant chordae)
3) Annular dilatation as part of ventricular dilatation (and therefor papillary shift) due to acute rheumatic myocarditis;
 but once the acute myocarditis had recovered isolated annular dilation without ant chordal elongation or ant /post leaflet shrinkage was not a cause of mitral incompetence. 

I did a small study comparing the effective orifice area in degenerative and rheumatic cases in which the annulus had been reduced to the same geometric area by annuloplasty. The EOA was in every case better with degenerative disease. Conclusion is obvious
Bob


-----Original Message-----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Thu, 28 Jun 2007 2.42am
Subject: Re: [HSF] Rheumatic mitral valve


Erdinc , in ehrumatic valvar regurg patients there is commonly annular dilatation. Carpentier's original ring with the 3:4 ratio was designed not for myxomatous but for rheumatic repairs. Having said that pure MS does not require a ring as these cases do not have annular dilatation. 
Prasanna 
erdinç naseri wrote: 
> Dear Igor, 
> Though I am not sure whether surgery is an option for this special patient but suppose so: implantation of an annular ring in mitral position will correct annular dilatation and resultant MR. even if she had MR that would be due to chordal fibrosis and shortening with tethering of the leaflets and also leaflet hypomobility due to fibrosis( typical of rheumatic valves). 
> In conclusion: > 1. There is no indication for prophylactic implantation of a ring 
> 2. Rheumatic MR is not due to annular dilatation( in irreversible phase, LV may dilate leading to annular dilatation) 
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