[HSF] Redo Radical Mitral Valvuloplasty

[Hgrmd at aol.com]

Prasanna,
  You made some really excellent points.  I particularly like the  one that 
true sizing the mitral orifice in a replacement could prevent possible  reverse 
remodeling.  
  I'm amazed at some of the repairs you've been able to do with your  
rheumatics.  Retraction of the P3 area is a major issue as well in ischemic  MR.  
However, MR in ischemic cardiomyopathy occurs in mitrals with leaflets  that are 
normal or thinned out.  This makes patching even more  difficult.  The case I 
did yesterday had leaflet that was thickened as with  typical myxomatous 
degeneration.  According to my op note, I had merely  closed a P2-P3 interscallop 
leak as well as a postero-medial commissuroplasty,  in addition to resuspending 
A1 and A2.  There was no evidence of pannus  overgrowth. I did not do a 
sliding leaflet plasty or any other type of posterior  leaflet resection. At 
operation, I could see no trace of that P2-P3 repair, and  I suspect it broke down.  
 In fact, that was the worst area of  leaflet retraction and source of leak 
on the initial saline test. 
  Parenthetically, this case was especially significant to me, because  it 
was the first case of myxomatous repair that I ever had to reoperate.   I'm not 
naive enough to believe that it's the only case that ever redeveloped a  
significant leak, but it's the only one that had been brought to my  attention.
Hal



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