[HSF] Mitral ring redux

[Edward Bender]

I'm not sure whether this is in the literature or not, but, my experience is
that one can divide these types of patients into two groups: those with
important pulmonary hypertension (> 1/2 systemic - my definition) and those
with no or mild pulmonary hypertension.  Both groups can survive surgery,
but the latter group is a lot easier to deal with post-operatively and, in
my experience, has a better long term outlook.

As to the pop-off valve theory, we all know it should be consigned to the
trash heap of failed ideas (along with the thought that MR will resolve
after revascularization alone).  These "attitudes" will probably not change
much. Teach the younger referring doctors and humor the older ones.  Read
Thomas Kuhn's Structure of Scientific Revolutions to understand that
paradigm shifts occur not by educating belief-holders, but by letting the
older tenet holders to die off or retire.

Ed Bender, MD


On 5/2/08 9:48 PM, "Mitch Lirtzman" <drmitch at cox.net> wrote:

> Please help clarify a point I made concerning mitral repair.
> 
> I have a 50yo male smoker with no history of drugs, EtOH, industrial
> exposure, etc, and rather severe CAD. The LAD is previously stented and
> occluded at it's origin. Fills rt-to lt. The Cx has a proximal 90% lesion.
> RCA normal. EF is 20%. LVEDD~ 7cm. TEE shows moderate MR with a central jet
> to mid-atrium. Septum and lateral walls still move. Previously refused by
> another surgeon. They putzed around with him at the local Charity hospital
> til he went into VT...and sent him to me. Still has occasional chest pains
> in ICU.
> 
> 
> Frankly, the guy has no chance without surgery and at high risk with it.
> I've done bunches of low-EF patients with quite satisfactory results. The
> question is that I plan to put a "quick" ring on his mitral as has been my
> practise for several years. You all know the possible scenario in six
> months with CHF and worsening MR, if the MR is not corrected. The
> cardiologist feels that his LV won't be able to take the added strain
> without that "pop-off valve".
> 
> Thanks in advance for your comments and advice in advance.
> Mitch 
> 
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