[HSF] Geoform: A Flawed Concept?

[Mark Levinson]

On Aug 18, 2007, at 12:45 PM, Rwmfglycar at aol.com wrote:

>
>    Was the leak through the interscallop clefts? If it was there   
> is NO
> surprise. It is an expected consequence of excessive shortening of the
> anteroposterior dimension instead of the normal general shortening  
> all the  radii.
> Believe it or not the Miller group actually found this when they  
> happened  to have
> markers on each side of the central - medial scallop cleft (P2-P3)   
> whiole they
> shortened the AntPost dimension.

Bob:

I have also noticed exaggeration of interscallop clefts as a  
consequence of annulplasty.   But I do
not think this is from reducing the AP diameter.    I think these  
clefts arise as a consequence of reducing
the valve circumference.   Most (if not all) of that reduction takes  
place in the posterior leaflet tissue and
so, as the tissue is gathered, it forms pleats.      Just like a  
purse or money pouch when you pull on the
draw-string... as the circumference is reduced, the abric folds into  
pleats.

Nearly all of the adult non-rheumatic cases of mitral regurgitation  
are associated with annular dilation, and thus
the circumference of the annulus is enlarged.   When the ring holds  
the valve in a reduced circumference, the posterior leaflet
folds into pleats, like the money pouch analogy.

If the pleats create a gap when opposed against the  anterior  
leaflet , I have found that an interrupted approximation
of the edges of the pleat solves the problem.    Since there is  
redundant leaflet tissue whenever this occurrs, the
solution is safe and simple.    It has saved me from jets at these  
pleats, which I believe accounts for many
of the "failures" reported by others.

Thanks.

Mark

Mark M. Levinson, MD
Founder, Editor-in-Chief,
The Heart Surgery Forum
WWW: <http://www.hsforum.com>
Email: <mmLevinson at hsforum.com>