[HSF] LV Aneurysm Repair

[erdinç naseri]

Ani,
I think in the future mitral repair of at least ischemic and myxomatous ethiologies must be included in the training program of all CTS centers.I am saying this because here more than 90% of the above mentioned cases end up either untreated or their valves replaced.
erdinc> From: anianyanwu at hotmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] LV Aneurysm Repair> Date: Sat, 23 Jun 2007 11:22:25 -0400> CC: > > Hal> > Why would you not have a 40mm ring on shelf for complex repairs? In our Barlow patients the most frequently used ring sizes are 38 and 40 mm. Also why did you not just shorten the anterior leaflet to reduce the potential for SAM as should be more straightforward than septal myomectomy?> > Your case does however illustrate the importance of such cases (asymptomatic complex repair) being limited to reference mitral surgeons. I remember we had a patient, also 72 yrs, transferred to us on a BiVAD last year after a failed repair. Was similar story to yours. Surgeon elsewhere did a 'mini-invasive' repair through a minithoracotomy and ends up with SAM. Unlike you he did not have tools or expertise to treat this (in retrsopect the ring was probably too small even - size 28 cosgrove for what seemed like Barlow's). Ended up hours later with a St Jude Valve after surgeon couldnt fix SAM, then myocardial failure, then sternotomy, then BiVAD. Then transferred to us where he died week later. He was also asymptomatic and played golf day before his surgery. > > Unless surgeons are versatile with advanced techniques of repair such as those you describe (or suitable alternatives) they really should not be undertaking asymptomatic repair, as in the patient I described a simple measure such as a different size ring or reducing height of anterior leaflet could have fixed the SAM and prevented fatality.> > Ani> > ----- Original Message -----> From: Hgrmd at aol.com> Sent: Friday, June 22, 2007 7:31 PM> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] LV Aneurysm Repair> > Dear Guiseppe,> Thanks for your input. When I was at the Society of Heart Valve Disease, > this paper by Rosenhek was discussed. Perhaps Bob Frater would care to chime > in as well. As I recall, the criticism of this paper was that the MR wasn't > truly severe. I do agree that surgeons shouldn't advise mitral repair in > asymptomatic patients unless they are nearly certain (95%) that a durable > repair will be the outcome. For simple problems like focal posterior prolapse or > annular dilatation, surgeons properly trained in these techniques should > suffice. However, for cases of massive Barlow's with bileaflet prolapse, those > patients should be referred to a high volume surgeon. An example: Yesterday > I operated on a 72 yo man with severe symptomatic MR from a diffuse anterior > leaflet prolapse with Barlow's disease. In addition, there was a sizable > bump on the basal septum, though no gradient across the LVOT. There was also 3+ > AI with a 25mm aortic annulus. The EF was 40%.> At operation, I resuspended A1 and A2 with Goretex. The anterior leaflet > was huge, and could have used a 40mm ring. The biggest I had available was a > 36mm Physio. After installing it, the posterior leaflet made 30-35% of the > septal-lateral height. The depth of coaptation at P2 was 20mm. I was quite > concerned there would be SAM. I then excised the myxomatous aortic valve. > Through the aortic orifice, I did a generous ventricular septal myomectomy in > order to make room for this huge anterior mitral leaflet. The aortic valve > was replaced with a 25mm C-E Magna. The patient came off pump on no > inotropes. The repair had zero MR and no SAM. The patient was extubated 6 hours > postop, and done well thus far. The point is that surgeons with little repair > experience would most likely have replaced this mitral valve. With the proper > training, they can be saved.> > Hal> > > > ************************************** See what's free at http://www.aol.com.> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------