Mitral valve repair
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Mitral valve repair. Anatomy. Mitral Stenosis. Opening of the valve is narrowed. Normal valve opening 4-6 cm sq. Symptoms 2-2.5 cm sq. Severe < 1 cm sq. Pathophysiology. High pressure in left atrium and lungs. Increase work of right ventricle. Atrial fibrillation. (palpitations)

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Mitral stenosis
Mitral Stenosis

Opening of the valve is narrowed.

Normal valve opening 4-6 cm sq.

Symptoms 2-2.5 cm sq.

Severe < 1 cm sq.


Pathophysiology
Pathophysiology

  • High pressure in left atrium and lungs.

  • Increase work of right ventricle.

  • Atrial fibrillation. (palpitations)

  • Stroke.


Causes of mitral stenosis
Causes of Mitral Stenosis

  • Rheumatic fever.

  • Congenital.


Rheumatic fever
Rheumatic fever

  • Immune complexes. (Strep throat/ renal infections)

  • Slow process.

  • Repeated attacks.

  • Replacement.


Indication for surgery
Indication for surgery

  • Valve opening area < 1.5 cm sq.

  • Gradient > 12mmHg.


Mitral incompetence
Mitral Incompetence

  • Valve does not close properly.

  • Blood flows back into the left atrium.

  • Volume overload of left ventricle.

  • Left ventricular failure.


Aetiology
Aetiology

  • Rheumatic Fever.

  • Endocarditis

  • Barlow's syndrome. (Floppy valve)

  • Ischemia.

  • Congenital.

  • Cardiomyopathy.


Carpentier classification
Carpentier classification

  • Type 1- Normal leaflet movement, annular dilatation. (cardiomyopathy)

  • Type 2- Increased leaflet movement, prolapsing segments. (Barlow's)

  • Type 3a- Restricted leaflet movement. ( Rheumatic)

  • Type 3b- Ischaemic leaflet retraction


Surgery
Surgery

  • General anaesthesia.

  • TEE on board.

  • Cardio-pulmonary bypass.

  • Cell saver.

  • Repair before replace.




Type 2 valve prolapse
Type 2 – Valve prolapse

  • To much thickened leaflet.

  • Stretched out chordae.

  • Elongated papillary muscles.

  • Leaflet prolaps.









Type 3 b ischaemic incompetence
Type 3 b- Ischaemic incompetence

  • Valve dysfunction because of impaired coronary blood flow.

  • Posterior leaflet retraction. (P3 area)

  • Needs to be fixed > moderate incompetence.

  • Remodelling annuloplasty.


Mitral valve replacement
Mitral valve replacement

  • Native valve removed.

  • Mechanical or Tissue prosthesis.




Mechanical mitral valve replacement
Mechanical mitral valve replacement

  • Surgical mortality 2% - 4%

  • Bleeding risk 1%/year

  • Thrombo-embolism 1%/year

  • Endocarditis 0.1%/year






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