[HSF] marfan

[Ani Anyanwu]

I think depends on the certainity with which you can repair his valve. He likely has Barlow-type bileaflet prolapse. If you cannot guarantee near 100% that you can repair the valve then I think best not to operate and wait till absolute indications for surgery for either the mitral valve, aorta or aortic valve.
 
In our centre, we would likely offer him a mitral valve repair. The aortic dimensions you describe, together with the absence of aortic incompetence, do not seem plausible - I would wait to validate the measurements by CT. If indeed any of the measures are more than 4cm we would offer aortic root surgery. Doing a David and a complex Barlow repair as a single procedure can be a very long ischemic time: in a borderline ventricle like yours our approach would be to stage the operations. So far we have always done a David or Yacoub first and the mitral shortly after or several months after (we did once such Marfan early this month who is now planning for the mitral valve repair).
 
Ani
> From: gbaslaim at hotmail.com> To: openheart-l at lists.hsforum.com> Date: Sat, 22 Sep 2007 12:49:17 +0300> Subject: [HSF] marfan> > > What would you advise as an operative plan for a 19 yr male (78 kg, 191 cm), NYHA II, Marfan, pectus, and decreased LV from normal to 45-50% over the last one year. His echo showed increased MR from trivial to mod-severe. normal trileaflet aortic valve. His diameters (mm) aortic annulus= 26, sinus= 42, STJ= 33, asc aorta= 27? > CT chest pending for pectus. No family H/O of sudden death or disection.> > G. Baslaim> Jeddah, KSA> _________________________________________________________________> Windows Live Spaces is here! It’s easy to create your own personal Web site.> http://spaces.live.com/signup.aspx> _______________________________________________> 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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