Mitral Valve Repair: How I Teach It

Preoperative transthoracic echocardiography is the cornerstone of imaging and provides information on annular size, leaflet and subvalvular apparatus anatomy (ie, tethering, flail, prolapse, perforation, or restriction of leaflets), and the location, direction, and quantitation of the regurgitant jet. Left ventricular size and function are also ascertained. Preoperative transesophageal echocardiography is used selectively when the feasibility and complexity of repair are unclear from transthoracic echocardiography and the need for surgery is in question. Intraoperative transesophageal echocardiography is used routinely; the conditions of anesthesia reduce the degree of MR to some extent. In general, our mitral repair strategy3 for segmental disease includes leaflet resection (triangular or quadrangular) for posterior leaflet disease, Gore-Tex artificial chords (W.L. Gore & Associates, Newark, DE) for anterior leaflet prolapse or flail, and routine use of a

Automated summary

Preoperative transthoracic echocardiography is essential for determining the type and severity of valve disease, while transesophageal echocardiography is selectively used when surgery is uncertain. Intraoperative transesophageal echocardiography is routinely used to aid in reducing valve regurgitation under anesthesia.