mitral valve repair degenerative disease. case #1 degenerative mitral repair u u 49 year old with...
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Mitral Valve RepairDegenerative 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 4ch 37mm Midcomm 46mm LAX 38mm
Height Anterior Leaflet 24mmPosterior Leaflet P1 12mm P2 20mm P3 19mm
LBP 08
LBP 09
LBP 11
LBP 31
Case #1
Procedure: Mitral Valve Repair1) Quadrangular resection of medial P2
with torn chordae followed by annular plication.
2) #31 Duran Ring
3) Mean Gradient 3.5mm Hg
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 4ch 45mm Anterior Leaflet Height 26mmPosterior Leaflet Height P1 19mm P2 22mm P3 17mm
Torn chordae P2
Midesophageal 5 Chamber View
Midesophageal 5 Chamber View
Midesophageal 4 Chamber View
Midesophageal Commissural View
Midesophageal Commissural View
Midesophageal Longitudinal View
4.3cm3.2cm
Case #2
Procedure:1) Quadrangular resection P2
2) Slide of P1 to height of 12-15mm
3) #33 Duran Ring
4) Mean Gradient 4mm Hg
Post Repair Post Repair LAX
Post Repair
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 Diameter4ch 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), valveSurface area (mm2), and chordal length (cm) are presented. AL = anterior leaflet.
Mitral Valve:H. Boudoulas & C. Wooley
Case #3
Procedure1) Quadrangular Resection P2 (4cm length)2) P1 – P3 slide3) Posterior Annular plication4) Shortening height of Anterior Leaflet
(Pomeroy incision @ base)5) New-chordae Ant Papillary to A1
Post Papillary to A2
6) #33 Duran Ring7) Mean Gradient 2mm Hg
SG 24
SG 25
SG 26
Case #4 Degenerative Mitral Valve Repair
55 year old followed for mitral regurgitationMost 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 Diameter4 ch 45mm Midcomm 52mm LAX
48mm
Anterior Leaflet Height 32mm
Posterior Leaflet HeightP1 25mm P2 26mm P3 22mm
(Flail)
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 Diameter4ch 46mm Midcomm 44mm LAX 41mm
Anterior Leaflet Height 30mmTorn chord to A2/A3 from posterior papillary
Posterior Leaflet HeightP1 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