Videos of Mitral Valve Repair |
Echocardiogram of Anterior Leaflet Prolapse |
Echocardiogram of Anterior |
Surgical Video of Mitral Valve Repair |
Closeup Video of a Mitral Valve Repair |
Echocardiogram of Posterior Leaflet Prolapse |
Echocardiogram of Posterior |
Mitral Valve Repair
Mitral valve repair is a complex and technically demanding procedure. The techniques have evolved over the last thirty years.
As mentioned above, the success rate depends on the condition of the valve and heart at the time of surgery as well as the skill and experience of the surgeon. There are generally three reasons a mitral valve leaks.
- Annular dilatation: The first is when the supporting structures around the valve, called the annulus, dilates. This causes the valve leaflets to be pulled apart.
- Leaflet prolapse: This means that the leaflet moves past the usual point of closure. If you imagine the leaflet as a swinging door, it is supposed to stop moving at just the right point to close and prevent leakage. However, if the leaflet keeps on moving, just like a swinging door it will move too far in the other direction, allowing blood to leak past it.
- Leaflet restriction or tethering: The third reason a valve will leak is if the leaflet is tethered or restricted in some fashion, and cannot rise up to meet the other leaflet to close properly.
For more information, see Mitral Valve Prolapse and Mitral Regurgitation.
Techniques
Annuloplasty
The simplest surgical technique is to narrow a dilated annulus and restore its natural shape.
Normally the mitral valve and annulus are shaped like a "D", but when dilated the shape is more like an "O".
Prosthetic rings of the appropriate size and shape can be sutured around the annulus to restore the size and shape.
Complex techniques
Different techniques are used to correct prolapse of a leaflet. Either the anterior (towards the front) or posterior (towards the back) leaflet may prolapse.
The techniques can be complex, but usually treatment of posterior leaflet prolapse involves cutting out the prolapsing portion and suturing the leaflet back together, and then putting in a prosthetic ring.
Treatment of anterior leaflet prolapse can be more tricky, but often involves creating artificial cords from suture material to replace the cords that are stretched or ruptured.
Tethered leaflets must be freed up in some fashion to restore their mobility.