[HSF] Redo Radical Mitral Valvuloplasty

[prasannasimha]

Hal, How many sutures had you put to close the cleft ? Do you have any 
recollection ? There seems to be a lot to learn from this case.
By a posteromedial commissuroplasty was it a Carpentier's magic stitch ?
Prasanna.


Hgrmd at aol.com wrote:
> 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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