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Mitral Valve Repair Degenerative Disease. Case #1 Degenerative Mitral Repair u u 49 year old with known myxomatous mitral valve disease and mitral regurgitation.

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Presentation on theme: "Mitral Valve Repair Degenerative Disease. Case #1 Degenerative Mitral Repair u u 49 year old with known myxomatous mitral valve disease and mitral regurgitation."— Presentation transcript:

1 Mitral Valve Repair Degenerative Disease

2 Case #1 Degenerative Mitral Repair u u 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. u u Annular Diameter 4ch 37mm Midcomm 46mm LAX 38mm u u Height Anterior Leaflet 24mm Posterior Leaflet P1 12mm P2 20mmP3 19mm

3 LBP 08

4 LBP 09

5 LBP 11

6 LBP 31

7

8

9 Case #1 Procedure: Mitral Valve Repair 1) 1) Quadrangular resection of medial P 2 with torn chordae followed by annular plication. 2) 2) #31 Duran Ring 3) 3) Mean Gradient 3.5mm Hg

10 LBP 47

11 Case #2 Degenerative Mitral Repair u u 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. u u Annular Diameter4ch 45mm Anterior Leaflet Height26mm Posterior Leaflet HeightP 1 19mm P 2 22mm P 3 17mm u u Torn chordae P 2

12 Midesophageal 5 Chamber View

13

14 Midesophageal 4 Chamber View

15 Midesophageal Commissural View

16

17 Midesophageal Longitudinal View

18 4.3cm 3.2cm

19

20 Case #2 Procedure: 1) 1) Quadrangular resection P 2 2) 2) Slide of P 1 to height of 12-15mm 3) 3) #33 Duran Ring 4) 4) Mean Gradient 4mm Hg

21 Post RepairPost Repair LAX Post Repair

22 Case #3 Degenerative Mitral Valve Repair

23 Case #3 u u 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. u u Mitral Annular Diameter 4ch 50mm Midcomm 57mmLAX 50mm u u Anterior Leaflet Height 34mm u u Posterior Leaflet Height P 1 20mmP 2 25mm P 3 20mm u u Barlow Type u u Both Anterior and Posterior Leaflet Prolapse

24 SG 01

25 SG 18

26 SAG05

27 SAG06

28 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 (mm 2 ), and chordal length (cm) are presented. AL = anterior leaflet. Mitral Valve: H. Boudoulas & C. Wooley

29 Case #3 Procedure 1) 1) Quadrangular Resection P 2 (4cm length) 2) 2) P 1 – P 3 slide 3) 3) Posterior Annular plication 4) 4) Shortening height of Anterior Leaflet (Pomeroy base) 5) 5) New-chordae Ant Papillary to A 1 Post Papillary to A 2 6) 6) #33 Duran Ring 7) 7) Mean Gradient 2mm Hg

30 SG 24

31 SG 25

32 SG 26

33 Case #4 Degenerative Mitral Valve Repair u u 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. u u Mitral Annular Diameter 4 ch 45mmMidcomm 52mm LAX 48mm u u Anterior Leaflet Height32mm u u Posterior Leaflet Height P 1 25mmP 2 26mmP 3 22mm (Flail)

34 Case #4_ 01

35 Case #4_ 04

36 Case #4_ 11

37 Case #4_ 18

38 Case #4 Procedure: “American Correction” 1) 1) New Chordae: 3 pairs to Anterior leaflet 3 pairs to Posterior leaflet 2) 2) #35 Ring 3) 3) Small Posterior Medial Commissural Plication

39 1 Case #4

40 2 Case #4

41 4 Case #4

42 8 Case #4

43 9 Case #4

44 Case #4_ 86

45 Case #4_ 89

46 Case #4_ 93

47 Case #5 Degenerative Mitral Valve Repair u u 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. u u Mitral Annular Diameter 4ch 46mmMidcomm 44mmLAX 41mm u u Anterior Leaflet Height 30mm Torn chord to A 2 /A 3 from posterior papillary u u Posterior Leaflet Height P 1 13mmP 2 15mm P 3 12mm

48 LW11

49 LW13

50 LW21

51 LW23

52 LW34

53 LW35

54 Case #5 Procedure: – –Neochordae Posterior Papillary to A 2 /A 3 – –#31 Duran Ring – –Mean Gradient 2.2mm Hg


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