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Review
. 2014 Mar;6 Suppl 1(Suppl 1):S39-51.
doi: 10.3978/j.issn.2072-1439.2013.10.20.

Review of mitral valve insufficiency: repair or replacement

Athanasios Madesis  1 , Kosmas Tsakiridis  1 , Paul Zarogoulidis  1 , Nikolaos Katsikogiannis  1 , Nikolaos Machairiotis  1 , Ioanna Kougioumtzi  1 , George Kesisis  1 , Theodora Tsiouda  1 , Thomas Beleveslis  1 , Alexander Koletas  1 , Konstantinos Zarogoulidis  1
Affiliations
Review

Review of mitral valve insufficiency: repair or replacement

Athanasios Madesis et al. J Thorac Dis. 2014 Mar.

Abstract

Mitral valve (MV) dysfunction is the second-most common clinically significant form of valvular defect in adults. MV regurgitation occurs with the increasing frequency of degenerative changes of the aging process. Moreover, other causes of clinically significant MV regurgitation include cardiac ischemia, infective endocarditis and rhematic disease more frequently in less developed countries. Recent evidence suggests that the best outcomes after repair of severe degenerative mitral regurgitation (MR) are achieved in asymptomatic or minimally symptomatic patients, who are selected for surgery soon after diagnosis on the basis of echocardiography. This review will focus on the surgical management of mitral insufficiency according to its aetiology today and will give insight to some of the perspectives that lay in the future.

Keywords: Mitral valve (MV); cardiothoracic surgery; interventional surgery.

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Figures

Figure 1
Figure 1
Normal and incompetent mitral valve. Abnormal coaptation of the two leaflets results in regurgitation of blood to the left atrium during systole. Carpentier’s classification of mitral valve incompetence according the underlying mechanism. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 2
Figure 2
Types of degenerative mtral valve disease. (A) Fibroelastic deficiency; (B) Barlow’s disease. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 3
Figure 3
Carpentier’s techniques involve resection of excessive tissue and reconstruction of the remnant valve. (A) Quadrangular resection of the P2 with reapproximation; (B) Quadrangular resection of the P2 with sliding plasty. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 4
Figure 4
Correction of a prolapsing anterior leaflet with placement of polytetrafluoroethylene (PTFE) neochordae. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 5
Figure 5
Technique for ring annuloplasty. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 6
Figure 6
Repair in rhematic mitral valve disease. The leaflets are thickened and akinetic. Stenosis of the valve is usually predominant but it incompetence may coexist. Commissurotomy and ring annuloplasty are performed. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 7
Figure 7
Technique of augmentation of the anterior mitral leaflet. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
Figure 8
Figure 8
Comparison of traditional and minimally invasive access for mitral valve surgery. (Reprinted with permission from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.).
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