[HSF] Rheumatic mitral valve

[A]

Ed: 
Please excuse the delay in my response. I only saw the message today. Some
times I take a break off the computer. LA size of 3.5 cm is rather small I
predict there will be thickened LA walls due to hypertrophy. I wish you luck
but let me tell you the exposure wouldn't be the greatest. By the way what
is the MVA? A trick that I found useful in such a setting is to take a back
hand suture with heavy silk through the middle of the posterior leaflet deep
and use it for retraction and exposure. One has be careful of the material
of the valve in pure MS the valve is thickened and it can withstand this
suture without any untoward effects. If and this is unlikely in the setting
of pure MS the leaflet appear fragile and soft the technique is inadvisable.
Best of luck

Ahmed 

-----Original Message-----
From: ebender001 at charter.net [mailto:ebender001 at charter.net] 
Sent: Wednesday, June 27, 2007 7:06 AM
To: OpenHeart-L at lists.hsforum.com
Cc: A
Subject: RE: [HSF] Rheumatic mitral valve

Ahmed:
LA size is 3.5 cm.
Normal coronaries.
Our cardiologists do not do balloon valvuloplasty.

Ed Bender, MD

---- A <alsadd at ksu.edu.sa> wrote: 
> 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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