Mitral Valve Repair Degenerative Disease

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Presentation transcript:

Mitral Valve Repair Degenerative 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 24mm Posterior Leaflet P1 12mm P2 20mm P3 19mm

LBP 08

LBP 09

LBP 11

LBP 31

Case #1 Procedure: Mitral Valve Repair Quadrangular resection of medial P2 with torn chordae followed by annular plication. #31 Duran Ring 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 26mm Posterior 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

4.3cm 3.2cm

Case #2 Procedure: Quadrangular resection P2 Slide of P1 to height of 12-15mm #33 Duran Ring Mean Gradient 4mm Hg

Post Repair Post Repair Post Repair LAX

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 Diameter 4ch 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), valve Surface area (mm2), and chordal length (cm) are presented. AL = anterior leaflet. Mitral Valve: H. Boudoulas & C. Wooley

Case #3 Procedure Quadrangular Resection P2 (4cm length) P1 – P3 slide Posterior Annular plication Shortening height of Anterior Leaflet (Pomeroy incision @ base) New-chordae Ant Papillary to A1 Post Papillary to A2 #33 Duran Ring Mean Gradient 2mm Hg

SG 24

SG 25

SG 26

Case #4 Degenerative Mitral Valve Repair 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. Mitral Annular Diameter 4 ch 45mm Midcomm 52mm LAX 48mm Anterior Leaflet Height 32mm Posterior Leaflet Height P1 25mm P2 26mm P3 22mm (Flail)

Case #4_ 01

Case #4_ 04

Case #4_ 11

Case #4_ 18

Case #4 Procedure: “American Correction” New Chordae: #35 Ring 3 pairs to Anterior leaflet 3 pairs to Posterior leaflet #35 Ring 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 Diameter 4ch 46mm Midcomm 44mm LAX 41mm Anterior Leaflet Height 30mm Torn chord to A2/A3 from posterior papillary Posterior Leaflet Height P1 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