@wcuro I hope I don't tread on any toes, but I have to speak up because what you say you have been told, about the scar tissue, or what you think you understand about what was said to you, is not in keeping with my understanding. Before I go on, I have no medical training.

When an electrophysiologist ablates the endothelial lining of the left atrium to stop the heart from fibrillating, he does create lesions which will ultimately heal, but they spread out a bit and create, if done properly and thoroughly, a complete circle of scarring around the affecting focus or entry point....usually around the pulmonary vein ostia. Later, there will be other re-entrants, but those develop with time and are found on the coronary sinus, in the left atrial appendage, in the septum, and so on....

The scarring is indeed impervious to the signals that need to travel through/over the endothelial lining. The wave propagation of energy travels over the endothelial lining and makes the myocytes under them contract...which is what we need the atrium to do.

You say you were told that scarring that took place years ago, by design, is now working against your heart's purpose of launching needed signals? How can this be? Why didn't scarring placed where it is currently located not cause tachycardia within days or weeks of the valve repair? Something doesn't add up.....to my uneducated mind.

Again, I'm not a physician, and I'm just trying to marry up what I understand about scar tissue and its effect on endothelial transmission, and how scarring around a valve repair could possibly cause tachycardia many years later. It sounds to me like both of us, you and I, need more understanding and a more comprehensive explanation. From there, your question just expressed in your post above mine should become more obviously replied to.

My Toronto based surgeon who is now 82 and retiring this summer is world famous….Dr Tirone David. He says he has done 3000 mitral valve repairs and 1000 scarred like mine and from the sounds of it, yours too. There is no way to predict who will have scarring and who won’t have excessive scarring. And maybe the annulus ring size is also an issue. Anyway, for my research to date it appears you can have a remodelling and they can remove the scarred annulus. But, it is very delicate and tricky surgery to remove the scarring and calcification. The easiest solution is to pop in a biological valve. The hardest is to remodel but no guarantees. They need to get in and see what’s there. A transesophageal echo should give a better picture of the extent of scarring. Scarring won’t be an issue with a pig valve but that will last only 10 years. I’m told I need a sternotomy but my surgeon is old school and probably not trained in minimally invasive cardiac surgery (mics). I suspect I won’t get out of continuous a fib till they fix the blockage! You may be in the same state. I’m looking for second opinions currently and my heath benefits will cover that from the Cleveland Clinic. But I’d have to mortgage my home to pay for surgery in the US. I’m looking at mitral valve experts at the Ottawa Heart Centre for consultation. I won’t stop searching till I get answers. I live in Nova Scotia and it’s limited when it comes to medical expertise given that the province has under 1 million population. So, I suggest you contact the CC and ask about debridement or remodelling. The valve may have calcified enough now that you don’t even need a ring anymore. But of course each case is different. My scarring is on top of the annulus. Keep asking questions and always look for a few opinions.