BRIEF COMMENTS
EXPERT: Prof. Henryk Siniawski MD, PhD
Affiliation: Deutsches Herzzentrum, Berlin, Germany
COMMENT
Surgery seems essential – it’s young patient with large ischemic area and LV dilatation. He has limited quality of life. Perhaps microreconstruction might be feasible. In case of patients disagreement for surgical treatment, I suggest exercise test 3 times a year – positive test with chest pain may motivate patient to agree for the operation.. Mitral regurgitation may have ischemic origin and may progress very fast. Mitral reconstruction should be considered.
EXPERT: Prof. Vladimir Alexi-Meskishvili, MD, PhD, pediatric cardiac surgeon
Affiliation: German Heart Instiute, Berlin
COMMENT
In case of congenital fistula surgery is necessary. No conservative treatment could be considered. Additionally mitral valve reconstruction may be considered. In case of single orifice – simple closure should be performed. Evaluation of the fistula anatomy is important. If there are many orifices present the risk of circumflex artery stenosis is higher. Best option is to open the atrium, find orifice of fistula and closed it from the inside. Anticoagulation should be administered.
EXPERT: Assoc. Prof. Bogusław Kapelak MD, cardiac surgeon
Affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow
COMMENT
Surgery is definitely indicated. Also mitral regurgitation should be repaired.
EXPERT: Jakub Podolec MD, PhD, cardiologist
Affiliation: Department of Hemodynamics, John Paul II Hospital, Krakow
COMMENT
Patient has recently recalled his consent for operation. Moreover we don’t know what caused mitral regurgitation. Maybe MitraClip could be considered as an option.
CONCLUSIONS
1) Surgery is indicated
2) Anticoagulants should be given due to the risk of thrombosis
3) Consider intervention on mitral valve
“Development of the European Network in Orphan Cardiovascular Diseases”
„Rozszerzenie Europejskiej Sieci Współpracy ds. Sierocych Chorób Kardiologicznych”
