[HSF] redo mitral case

[Ani Anyanwu]

Well when you say she "now has" 3+ MR, large LA, borderline enlarged LV I presume these never existed before? If so this MR has likely recurred quite a while ago (or less likely could have had residual MR from time of surgery). You did not say the etiology of her mitral disease - progression of native disease is probably the culprit in up to half of 'failures' after mitral valve repair. Some diseases are more likely to progress or recur than others. She could for example have had a new chordal rupture. Mitral annular calcification could progress. If endocarditis, she could be reinfected (and also could embolize to occlude a vein graft). Related to the repair itself, annular dilatation is a possibility, though less likely as she had some form of annuloplasty. Provided there was no residual MR I do not think this will turn out a technical failure 7 years later.
 
I do not know why you bring up the issue of a blocked bypass. Between the lines there seems to be some connection (or why mention it?) but that connection I cannot see.
 
You are withholding information vital to our understanding of the first procedure and also her current situation. When you provide it to us you might get more constructive comments rather than the expected voicing of opinions and biases.
 
Ani



> Date: Thu, 18 Oct 2007 14:01:07 -0700> From: tacuff at swbell.net> Subject: Re: [HSF] redo mitral case> To: OpenHeart-L at lists.hsforum.com> CC: > > Guess first.> > tea> > > ----- Original Message ----> From: Ani Anyanwu <anianyanwu at hotmail.com>> To: openheart-l at lists.hsforum.com> Sent: Thursday, October 18, 2007 3:20:33 PM> Subject: RE: [HSF] redo mitral case> > > Tea> > What is the mechanism of the Mitral regurgitation?> > Ani> > > > > Date: Thu, 18 Oct 2007 12:55:28 -0700> From: tacuff at swbell.net> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] redo mitral case> > I'm am kinda of wondering whether I caused the HSF to "crash" after my last "random" post.> > If not, maybe some would like to comment on a recent patient. > > A mid 70s female re-presented to me 7 years after a CAB X 1 and mitral repair (posterior quad resection with suture annuloplasty). Her symptoms are primarily fatigue with associated DOE.> > She now has 3+ MR with large LA, borderline enlarged LV, moderate TR, normal RV size and function, and occluded graft to the LAD. There are, to me at least, some quixotic issues in this case and to follow intraop. Excuding the theory that I am an inferior surgeon, which fortunately is not provable based on one case, does anyone wish to guess the findings, suggest possible causes, and make specific recommendations?> > tea> _______________________________________________>> 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> -----------------------------------------> _________________________________________________________________> The next generation of MSN Hotmail has arrived - Windows Live Hotmail> http://www.newhotmail.co.uk_______________________________________________> 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> -----------------------------------------
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