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J Thorac Cardiovasc Surg 2007;133:142-143
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

The first 20% of the full text of this article appears below.

Dr James I. Fann (Stanford, Calif). Dr Brown, I first want to congratulate you on an interesting and comprehensive presentation. It is always valuable to reevaluate one’s experience with a difficult complication after what otherwise should be a gratifying procedure.

You and your colleagues have provided an analysis of over 2000 patients in a 10-year period and confirmed that SAM after mitral valve repair occurs in a small fraction of patients. As you mentioned, for those at risk for SAM, mainly those with myxomatous disease and prolapse, the incidence is 11%. What is of more interest and clinical challenge are those patients with outflow tract obstruction, which occurred in 34 patients, or to put it another way, in 2% of all patients in the series. Your approach to treatment was medical with volume infusion, ß-blockade, vasoconstriction, and cessation of inotropic agents. I agree with this approach, although there are times when during the postoperative management and the patient is not doing so well that perhaps it might have been easier to have done an adjunctive procedure after establishing the diagnosis of outflow tract obstruction. Do you think a more aggressive approach should be used in the subset of patients with . . . [Full Text of this Article]


Related Article

Systolic anterior motion after mitral valve repair: Is surgical intervention necessary?
Morgan L. Brown, Martin D. Abel, Roger L. Click, Ronald G. Morford, Joseph A. Dearani, Thoralf M. Sundt, Thomas A. Orszulak, and Harzell V. Schaff
J. Thorac. Cardiovasc. Surg. 2007 133: 136-143. [Abstract] [Full Text] [PDF]





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