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MITRAL VALVE REPAIR

EXPERIENCE IN HARAPAN KITA HOSPITAL

Maizul Anwar ,MDNATIONAL CARDIOVASCULAR CENTER HARAPAN KITA

I N D O N E S I A

2008

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a!"#r$un%

Mitral Valve Repair is applicable in the majority of the

patients and has become the procedure of choice.

We have been using several techniques in order to

widen the spectrum of patients eligible for MV Repair.

This variation leads to several variation on result of

the operation and the patient characteristic.

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Mitral Valve Repair v.sMitral Valve Repair v.s

Mitral Valve Replacement Mitral Valve Replacement

AdvantagesAdvantages

Preservation of LV functionPreservation of LV function

Low rates of thromboembolismLow rates of thromboembolism

Lack of a requirement forLack of a requirement for

anticoagulantsanticoagulants !cellent duration!cellent duration

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Pa&i'n& ( )'&*$%+

retrospective review of !" patients who underwent

isolated MV repair from #anuary $%%& to 'ecember $%%(in )arapan *ita )ospital #a+arta.

The operation was performed through a median

sternotomy employing moderate systemic hypotermiaand antegrade,retrograde cold blood cardioplegia.

transesophageal echocardiography e-amination was

carried out intraoperatively immediately before and after

repair.

Transthoracic echocardiography was performed before

discharge.

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Results

Mean ge was !&$(/0&!% years. Male &102 and female !3"2.

4reoperative 56) was class 77 in 30$2 class 777 in $832 and class 7V

in 0%$2. 9tiology of MV disease was degenerative 81(2 rheumatic

0!12 and endocarditis $2.:eft ventricular end;diastolic dimensioninus rhythm was (1&2 and atrial fibrillation was $!&2.

>everal procedure MV Repair was performed in these patients. Mean 7AB

stay was $10/!0% day. MR grading after repair was none in $3&2

trivial in !$"2 mild in $3&2 and moderate in !02. 7n;hospital mortality

was !02.

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Valular L'+i$n N$- ./

nnular dilatation 0

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Type I Type IIIa

Type II Type IIIb

Annulus dilatationAnnulus dilatation

LeafletLeafletperforationperforation

RupturedRupturedchordaechordae

ElongatedElongatedchordaechordae

RuptureRupturepapillarypapillarymusclesmuscles

ElongatedElongated

papillarypapillarymusclesmuscles

CommissureCommissurefusionfusion

Leaflet thickeningLeaflet thickening

Chordae fusionChordae fusion

VentricularVentricular

dilatationdilatationVentricularVentriculardyskinesiadyskinesia

A Carpentier : J Thorac Cardiovasc Surg 1983;86:323-37

Mitral valve 4rolapseMitral valve 4rolapse

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MV R'1air 1r$!'%ur' N$- ./

:eaflet resectionCRing 03 :eaflet resectionCRingCcommisuroplasty 0

:eaflet resectionCAhordalCRing 8

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:eaflet Resectiion:eaflet Resectiion

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Chordal Transfer

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Ring nnuloplastyRing nnuloplasty

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rtificial Ahordaertificial Ahordae

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T1' $3

!$)1li!a&i$n4)$r5i%i&

N$- ./

>tro+eCMR> infection 0

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C$n!lu+i$n

M$+& $3 &*' 1a&i'n&+ a& )i%%l' a#', N6HA !la++ II, +inu+

r*&*) an% n$r)al E7- T*' +iz' $3 &*' *'ar& wi&*in +li#*&ln$r)al li)i&

M$+& $3 &*' 1a&i'n&+ w'r' %'#'n'ra&i', wi&* !*$r%al ru1&ur',

an% PML 1r$la1+'-

E'r 1a&i'n& un%'rw'n& +''ral $1'ra&i$n 1r$!'%ur'+

l'a3l'& r'+'!&i$n, !*$r%al 1r$!'%ur', an% ar&i3i!ial !*$r%a'

wi&* rin# annul$1la+& 3$r )$+& $3 &*' 1a&i'n&+-

T*' )$+& !$))$n )$r5i%i& w'r' r'9':1l$ra&i$n '!

5l''%in#4&a)1$na%' an% a!u& r'nal 3ailur'-

In9*$+1i&al )$r&ali& wa+ ;/- Cau+' $3 %'a&* wa+ +'1&i!

+n%r$)'-

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THANK 6OUTHANK 6OU