Mitral Valve Repair Degenerative Disease

1. Mitral Valve RepairDegenerative Disease

2. 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 24mmPosterior Leaflet P1 12mm P2 20mm P3 19mm

3. LBP 08

4. LBP 09

5. LBP 11

6. LBP 31

9. Case #1 Procedure: Mitral Valve Repair • Quadrangular resection of medial P2with torn chordae followed by annular plication. • #31 Duran Ring • Mean Gradient 3.5mm Hg

10. LBP 47

11. 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 26mmPosterior Leaflet Height P1 19mm P2 22mm P3 17mm • Torn chordae P2

12. Midesophageal 5 Chamber View

13. Midesophageal 5 Chamber View

14. Midesophageal 4 Chamber View

15. Midesophageal Commissural View

16. Midesophageal Commissural View

17. Midesophageal Longitudinal View

18. 4.3cm 3.2cm

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

21. Post Repair Post Repair Post Repair LAX

22. Case #3 Degenerative Mitral Valve Repair

23. 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

24. SG 01

25. SG 18

26. SAG05

27. SAG06

28. 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

29. 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

30. SG 24

31. SG 25

32. SG 26

33. Case #4 Degenerative Mitral Valve Repair • 55 year old followed for mitral regurgitationMost 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)

34. Case #4_ 01

35. Case #4_ 04

36. Case #4_ 11

37. Case #4_ 18

38. Case #4 Procedure: “American Correction” • New Chordae: 3 pairs to Anterior leaflet 3 pairs to Posterior leaflet • #35 Ring • Small Posterior Medial Commissural Plication

39. 1 Case #4

40. 2 Case #4

41. 4 Case #4

42. 8 Case #4

43. 9 Case #4

44. Case #4_ 86

45. Case #4_ 89

46. Case #4_ 93

47. 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

48. LW11

49. LW13

50. LW21