1 / 36

Mitral valve repair

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)

egan
Télécharger la présentation

Mitral valve repair

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mitral valve repair

  2. Anatomy

  3. 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.

  4. Pathophysiology • High pressure in left atrium and lungs. • Increase work of right ventricle. • Atrial fibrillation. (palpitations) • Stroke.

  5. Causes of Mitral Stenosis • Rheumatic fever. • Congenital.

  6. Rheumatic fever • Immune complexes. (Strep throat/ renal infections) • Slow process. • Repeated attacks. • Replacement.

  7. Indication for surgery • Valve opening area < 1.5 cm sq. • Gradient > 12mmHg.

  8. Mitral Incompetence • Valve does not close properly. • Blood flows back into the left atrium. • Volume overload of left ventricle. • Left ventricular failure.

  9. Aetiology • Rheumatic Fever. • Endocarditis • Barlow's syndrome. (Floppy valve) • Ischemia. • Congenital. • Cardiomyopathy.

  10. 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

  11. Surgery • General anaesthesia. • TEE on board. • Cardio-pulmonary bypass. • Cell saver. • Repair before replace.

  12. Type 1: Annulus dilatation

  13. Remodelling annuloplasty

  14. Type 2 – Valve prolapse • To much thickened leaflet. • Stretched out chordae. • Elongated papillary muscles. • Leaflet prolaps.

  15. Mitral valve segments

  16. Quadrangular excision repair

  17. TEE- Post repair

  18. Triangular excision repair

  19. Artificial chordoplasty

  20. Artificial chordoplasty and cleft repair

  21. Type 3a- Rheumatic valves

  22. 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.

  23. Mitral valve replacement • Native valve removed. • Mechanical or Tissue prosthesis.

  24. Mechanical prosthesis

  25. Tissue prosthesis

  26. Mechanical mitral valve replacement • Surgical mortality 2% - 4% • Bleeding risk 1%/year • Thrombo-embolism 1%/year • Endocarditis 0.1%/year

  27. Clotted mitral valve

  28. Pannus ingrowth

  29. Minimally invasive mitral surgery

  30. The future- Robotic surgery

More Related