1. Surgical repair of the congenitally malformed mitral valve in infants and children 
Elias A Zias, MD, Constantine Mavroudis, MD, Carl L Backer, MD, Lisa M Kohr, Nina L Gotteiner, MD, Albert P Rocchini, MD 
The Annals of Thoracic Surgery 
Volume 66, Issue 5, Pages (November 1998)
DOI: /S (98)

2. Fig 1
(A) Cleft anterior mitral valve leaflet. (B) The repair is accomplished by simple, interrupted, and inverted sutures. (C) Closure of the cleft will result in a competent valve without added annuloplasty techniques in a great majority of cases.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

3. Fig 2
(A) Artist’s representation of an insufficient mitral valve due to annular dilatation. Dotted lines represent the proposed posterior leaflet quadrangular resection and valvular incisions for the sliding plasty. (B) After the quadrangular resection, linear incisions are made in the posterior leaflet to accomplish the sliding valvuloplasty (arrows). (C) The posterior annulus is brought together with care not to injure the circumflex coronary artery. The resultant tightening of the annulus brings the remaining scallops of the posterior leaflets in a position for valvular repair. (D) The repair is strengthened by a semicircular Gore-Tex (W. L. Gore & Assoc, Flagstaff, AZ) strip. The anterior annulus was not included in the annuloplasty technique due to somatic growth considerations.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

4. Fig 3
Diagrammatic lateral cut-away view of a stenotic mitral valve caused by a restrictive supravalvular fibrous ring. Sharp dissection can free the fibrous ring from the native annulus, frequently resulting in dramatic increases in orifice size.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

5. Fig 4
Rarely a fibrous mitral ring can be found within the substance of the mitral valve leaflets causing valve stenosis (midvalvular ring), as well as leaflet restriction. Oftentimes, associated obstructive lesions can be identified which will require therapy, such as excess valvular tissue and fused papillary muscles.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

6. Fig 5
Diagrammatic (A) left atrial and (B) cut-away atrioventricular views of a double-orifice mitral valve. More commonly, the smaller of the two orifices is in the right lateral position. The degree of stenosis is variable. Effective orifice enlarging reparative techniques have not been developed.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

7. Fig 6
Cut-away atrioventricular view (A) and left atrial views (B, C) of a stenotic parachute mitral valve. (A) A single papillary muscle or fused papillary muscles usually arise from the posterior left ventricular wall. (B) The dotted lines show the areas of proposed leaflet fenestrations and papillary muscle incision to open the ventricular inlet. (C) Leaflet fenestrations are accomplished to maximize unrestricted blood flow into the left ventricle during diastole while preserving enough valvular tissue for effective coaptation during systole. The fused papillary muscle is being incised to facilitate valvular mobility.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )