Transcript Mitral Valve

Mitral Valve Repair
Degenerative Disease
Case #1
Degenerative Mitral Repair

49 year old with known myxomatous mitral valve
disease and mitral regurgitation. Now with symptoms
limiting activities. Severe mitral regurgitation with torn
chordae to posterior leaflet.
Referred for mitral valve repair.

Annular Diameter

Height Anterior Leaflet 24mm
Posterior Leaflet
P1 12mm
4ch 37mm
Midcomm 46mm
P2 20mm
LAX 38mm
P3 19mm
LBP 08
LBP 09
LBP 11
LBP 31
Case #1
Procedure: Mitral Valve Repair
Quadrangular resection of medial P2
with torn chordae followed by annular
plication.
2) #31 Duran Ring
3) Mean Gradient 3.5mm Hg
1)
LBP 47
Case #2
Degenerative Mitral Repair

65 year old man presenting c/o fatigue.
Found to have myxomatous mitral valve
with +3 regurgitation.
Follow-up over 6 months revealed progression
of mitral regurgitation and LV dilation.
Referred for mitral valve repair.

Annular Diameter
Anterior Leaflet Height
Posterior Leaflet Height

Torn chordae P2
4ch 45mm
26mm
P1 19mm P2 22mm
P3 17mm
Midesophageal 5
Chamber View
Midesophageal 5
Chamber View
Midesophageal 4
Chamber View
Midesophageal
Commissural View
Midesophageal
Commissural View
Midesophageal
Longitudinal View
4.3cm
3.2cm
Case #2
Procedure:
Quadrangular resection P2
2) Slide of P1 to height of 12-15mm
3) #33 Duran Ring
4) Mean Gradient 4mm Hg
1)
Post Repair
Post Repair
Post Repair LAX
Case #3
Degenerative Mitral Valve Repair
Case #3

57 year old woman with known myxomutous mitral
valve disease and severe mitral regurgitation.
Six month follow-up showed increasing LV
dimension and 10% decrease in EF.
Referred for repair.

Mitral Annular Diameter
4ch 50mm Midcomm 57mm LAX 50mm

Anterior Leaflet Height 34mm

Posterior Leaflet Height
P1 20mm
P2 25mm
P3 20mm

Barlow Type

Both Anterior and Posterior Leaflet Prolapse
SG 01
SG 18
SAG05
SAG06
Floppy mitral valve. Graphic presentation of the morphological characteristics of normal mitral valve
And floppy mitral valve associated with severe mitral valvular regurgitation. Valve diameter (mm), valve
Surface area (mm2), and chordal length (cm) are presented. AL = anterior leaflet.
Mitral Valve:
H. Boudoulas & C. Wooley
Case #3
Procedure
1)
2)
3)
4)
5)
6)
7)
Quadrangular Resection P2 (4cm length)
P1 – P3 slide
Posterior Annular plication
Shortening height of Anterior Leaflet
(Pomeroy incision @ base)
New-chordae
Ant Papillary to A1
Post Papillary to A2
#33 Duran Ring
Mean Gradient 2mm Hg
SG 24
SG 25
SG 26
Case #4
Degenerative Mitral Valve Repair

55 year old followed for mitral regurgitation
Most recent echocardiogram showed severe MR,
with flail segment of posterior leaflet of mitral valve
and dilation of LV. Relatively asymptomatic.
Referred for repair.

Mitral Annular Diameter
4 ch 45mm
Midcomm 52mm

Anterior Leaflet Height
32mm

Posterior Leaflet Height
P1 25mm
P2 26mm
(Flail)
LAX 48mm
P3 22mm
Case #4_ 01
Case #4_ 04
Case #4_ 11
Case #4_ 18
Case #4
Procedure: “American Correction”
1) New Chordae:
3 pairs to Anterior leaflet
3 pairs to Posterior leaflet
2) #35 Ring
3) Small Posterior Medial Commissural
Plication
1 Case #4
2 Case #4
4 Case #4
8 Case #4
9 Case #4
Case #4_ 86
Case #4_ 89
Case #4_ 93
Case #5
Degenerative Mitral Valve Repair

58 year old male with sudden onset of malaise and flu
like symptoms. Found to have new onset murmur and
severe mitral regurgitation.
Referred for mitral valve repair.

Mitral Annular Diameter
4ch 46mm
Midcomm 44mm
LAX 41mm

Anterior Leaflet Height
30mm
Torn chord to A2/A3 from posterior papillary

Posterior Leaflet Height
P1 13mm
P2 15mm
P3 12mm
LW11
LW13
LW21
LW23
LW34
LW35
Case #5
Procedure:
– Neochordae
Posterior Papillary to A2/A3
– #31 Duran Ring
– Mean Gradient 2.2mm Hg