Slide 1

Mitral valve repair

Slide 2

Anatomy

Slide 3

Slide 4

Mitral Stenosis Opening of the valve is narrowed. Normal valve opening 4-6 cm sq. Symptoms 2-2.5 cm sq. Severe < 1 cm sq.

Slide 5

Pathophysiology High pressure in left atrium and lungs. Increase work of right ventricle. Atrial fibrillation. (palpitations) Stroke.

Slide 6

Causes of Mitral Stenosis Rheumatic fever. Congenital.

Slide 7

Rheumatic fever Immune complexes. (Strep throat/ renal infections) Slow process. Repeated attacks. Replacement.

Slide 8

Indication for surgery Valve opening area < 1.5 cm sq. Gradient > 12mmHg.

Slide 9

Slide 10

Mitral Incompetence Valve does not close properly. Blood flows back into the left atrium. Volume overload of left ventricle. Left ventricular failure.

Slide 11

Aetiology Rheumatic Fever. Endocarditis Barlow's syndrome. (Floppy valve) Ischemia. Congenital. Cardiomyopathy.

Slide 12

Carpentier classification Type 1- Normal leaflet movement, annular dilatation. (cardiomyopathy) Type 2- Increased leaflet movement, prolapsing segments. (Barlow's) Type 3a- Restricted leaflet movement. ( Rheumatic) Type 3b- Ischaemic leaflet retraction

Slide 13

Surgery General anaesthesia. TEE on board. Cardio-pulmonary bypass. Cell saver. Repair before replace.

Slide 14

Type 1: Annulus dilatation

Slide 15

Remodelling annuloplasty

Slide 16

Slide 17

Type 2 Valve prolapse To much thickened leaflet. Stretched out chordae. Elongated papillary muscles. Leaflet prolaps.

Slide 18

Mitral valve segments

Slide 19

Quadrangular excision repair

Slide 20

Slide 21

TEE- Post repair

Slide 22

Slide 23

Triangular excision repair

Slide 24

Artificial chordoplasty

Slide 25

Artificial chordoplasty and cleft repair

Slide 26

Type 3a- Rheumatic valves

Slide 27

Type 3 b- Ischaemic incompetence Valve dysfunction because of impaired coronary blood flow. Posterior leaflet retraction. (P3 area) Needs to be fixed > moderate incompetence. Remodelling annuloplasty.

Slide 28

Slide 29

Mitral valve replacement Native valve removed. Mechanical or Tissue prosthesis.

Slide 30

Mechanical prosthesis

Slide 31

Tissue prosthesis

Slide 32

Mechanical mitral valve replacement Surgical mortality 2% - 4% Bleeding risk 1%/year Thrombo-embolism 1%/year Endocarditis 0.1%/year

Slide 33

Clotted mitral valve

Slide 34

Pannus ingrowth

Slide 35

Minimally invasive mitral surgery

Slide 36

The future- Robotic surgery