[HSF] Rheumatic mitral valve

[A]

Prasanna:
Agree with you I am just as puzzled about the Ed's cardiologists. Ours
wouldn't have asked us. 


Ahmed
-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
Sent: Wednesday, June 27, 2007 3:00 AM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Rheumatic mitral valve

Igor, why does a pure mitral stenosis ever have to have a ring ? That is 
redundant. The ring is required for annular remodeling in a regurgitant 
valve.
For years we have done closed and open mitrals in probably running into  
thousands  and they all have not required rings . If associated with MR 
definitely.
Release of the subvalvar  and posterobasal chordae etc are an integral 
part of commissurotomy.
My one worry is why have the cardiologists not ballooned this patient.
Prasanna
Igor Rudez wrote:
> Dear Ed,
> I think that not only commisurotomy is needed. You might also need to
resect
> some of the secondary cordae of the posterior leaflet and you might also
> need to enlarge posterior leaflet with a patch of pericardium! I allways
put
> a ring (why not?) at the end of the procedure! This is how I was taught by
> Robert Dion. It works, so why change winning combination!
>
> Igor Rudez
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of A
> Sent: Wednesday, June 27, 2007 7:15 PM
> To: OpenHeart-L at lists.hsforum.com; 'OpenHeart-L'
> Subject: RE: [HSF] Rheumatic mitral valve
>
>
> 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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