Importance of Imaging for Degenerative and Barlow‘s Disease Michael A. Borger MD PhD Columbia University Medical Center New York Presbyterian.

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Presentation transcript:

Importance of Imaging for Degenerative and Barlow‘s Disease Michael A. Borger MD PhD Columbia University Medical Center New York Presbyterian

What Do I Want to Know From Pre-MV Repair Imaging? Direction of regurgitant jet Complex or simple MR jet Area of prolapse or leaflet restriction Location of unexplained jet Length of AML Length of left ventricle Distance to circumflex artery

P2 Prolapse: 3D TEE Assessment

P2 Prolapse: Assessing Pathology

P2 Prolapse: Loop Measurement

P2 Prolapse: Securing Loops to PM

Insertion of Loops on Leaflet

Water Test

Watch For „Secondary“ Lesions

Finding and Correcting „Secondary“ Lesions

A2 / A3 Cleft Closure

Post-Cleft Closure Water Test

Barlow’s Pathognomonic Findings Leaflet thickening Redundant tissue Chordal lengthening Bileaflet prolapse / billowing Annular dilatation +/- Calcification D. Adams

TTE View of Barlow’s Valve

Barlow’s Valve: Intraoperative Inspection

Stitch (Prolene 4-0) enters 1 cm from AML free edge and exits 1 cm from posterior annulus Edge-to-Edge Barlow’s MV Repair

Barlow’s Edge-to-Edge: Sealing Test

Post-Alfieri for Barlow’s Echo

Valve area: 3.0 cm 2 Gradient: 3 mm Hg (mean) Post-Alfieri for Barlow’s Echo

Relative Contraindications to Edge-to-Edge Barlow’s Repair - asymmetric prolapse - multiple flail segments - small annulus (rare)

Assymetric Barlow’s TEE

Assymetric (“bifid”) Barlow’s

Assymetric Barlow’s

Assymetric Barlow’s: Loop Repair

Assymetric Barlow’s: Assessing Repair

Thank you!