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Mitral valve

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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

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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

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

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posterior leaflet (P2 segment)

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Salin test after repair

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

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II A2 P2

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Copyright 1999 The American Association for Thoracic Surgery d

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Alfieri Tech

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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

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

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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

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mitral dilated cardiomyopaty(IIIb)

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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

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

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Geoeform annuloplasty reduced AP distance elevated P2 segment

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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.

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Vein Harvesting

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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