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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Presentation Transcript
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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