1. Mitral valve

2. Repair vs. Replacement >%80 of MR are repairable Produces more physiological flow states It better preserves LV function Less thrombolic events Betters survival Long durability Lower risk of endocarditis

4. Meta-analysis repair versus replacement for ischemic mitral regurgitation. 2011 9 study mitral valve repair for IMR is associated with better short-term and long-term survival compared to mitral valve replacement

5. Functional Anatomy Mitral annulus Anterior Leaflet Posterior Leaflet Chordea Papillary Muscles Left ventricle Left Atrium

13. posterior leaflet (P2 segment)

14. Salin test after repair

15. Copyright ©2008 The Society of Thoracic Surgeons Folding Valvuloplasty Without Leaflet Resection

20. II A2 P2

22. Copyright ©1999 The American Association for Thoracic Surgery d

29. Alfieri Tech

31. Sizing Of Ring Degenerative normal leaflet: normal ring size Long Leaflet :Larger ring size Rheumatic & Endocarditis: normal ring size IMR : smaller ring size complete Rigid

47. Acute IMR Revascularizasion the same time Central jet and normal mitral aparatus--  Ring If not-  MVR with Chordal preserving and bio prothesis

49. chronic IMR(CAD) 3+ and4+( repair) 2+ if lv dysfunction or incomplete revascularization(Repair) 1+ if fluctuant MR or intra op TEE :need to repair

51. mitral dilated cardiomyopaty(IIIb)

52. Techniques If central jet  repair If eccentric or complex lesion  replace If post leaflet angle>45  replace 2 size undersize ring Very low SAM risk Sadle shape ring better than flat ring

53. Figure 1. Method of mitral leaflet angle quantification. Magne J et al. Circulation 2007;115:782-791 Copyright © American Heart Association

55. Geoeform annuloplasty reduced AP distance elevated P2 segment

56. Technique of the papillary muscle elevation. Ueno T et al. Interact CardioVasc Thorac Surg 2007;6:9-11 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

60. Vein Harvesting

62. Annuloplasty Rings and MRI relatively minor magnetic field interactions no report of a patient incident or injury MRI at 3-Tesla Since the magnetic field deemed minimal compared with the force exerted by the beating heart (ie, approximately 7.2 N