Cardiac Valve Repair Current Methods Mitral valve Repair

Repair vs. Replacement �>%80 of MR are repairable �Produces more physiological flow states �It

Meta-analysis repair versus replacement for ischemic mitral regurgitation . � 2011 � 9 study

Functional Anatomy �Mitral annulus �Anterior Leaflet �Posterior Leaflet �Chordea �Papillary Muscles �Left ventricle �Left

Folding Valvuloplasty Without Leaflet Resection Copyright © 2008 The Society of Thoracic Surgeons

d Copyright © 1999 The American Association for Thoracic Surgery

Sizing Of Ring Degenerative normal leaflet: normal ring size Long Leaflet : Larger ring

Acute IMR �Revascularizasion the same time �Central jet and normal mitral aparatus-- Ring �If

chronic IMR(CAD) � 3+ and 4+( repair) � 2+ if lv dysfunction or incomplete

Techniques �If central jet repair �If eccentric or complex lesion replace �If post leaflet

Figure 1. Method of mitral leaflet angle quantification. Magne J et al. Circulation 2007;

Geoeform annuloplasty reduced AP distance elevated P 2 segment

Technique of the papillary muscle elevation. Ueno T et al. Interact Cardio. Vasc Thorac

Annuloplasty Rings and MRI relatively minor magnetic field interactions no report of a patient

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Cardiac Valve. Repair: Current Methods Mitral valve

Repair vs. Replacement �>%80 of MR are repairable �Produces more physiological flow states �It better preserves LV function �Less thrombolic events �Betters survival �Long durability �Lower risk of endocarditis

Meta-analysis repair versus replacement for ischemic mitral regurgitation . � 2011 � 9 study � mitral valve repair for IMR is associated with better short-term and long-term survival compared to mitral valve replacement

Functional Anatomy �Mitral annulus �Anterior Leaflet �Posterior Leaflet �Chordea �Papillary Muscles �Left ventricle �Left Atrium

posterior leaflet (P 2 segment)

Salin test after repair

II A 2 P 2

Alfieri Tech

Sizing Of Ring Degenerative normal leaflet: normal ring size Long Leaflet : Larger ring size Rheumatic & Endocarditis: normal ring size IMR : smaller ring size complete Rigid

Acute IMR �Revascularizasion the same time �Central jet and normal mitral aparatus-- Ring �If not- MVR with Chordal preserving and bio prothesis

chronic IMR(CAD) � 3+ and 4+( repair) � 2+ if lv dysfunction or incomplete revascularization(Repair) � 1+ if fluctuant MR or intra op TEE : need to repair

mitral dilated cardiomyopaty(IIIb)

Techniques �If central jet repair �If eccentric or complex lesion replace �If post leaflet angle>45 replace � 2 size undersize ring �Very low SAM risk �Sadle shape ring better than flat ring

Geoeform annuloplasty reduced AP distance elevated P 2 segment

Vein Harvesting

Annuloplasty Rings and MRI relatively minor magnetic field interactions no report of a patient incident or injury MRI at 3 -Tesla Since the magnetic field deemed minimal compared with the force exerted by the beating heart (ie, approximately 7. 2 N