View
0
Download
0
Category
Preview:
Citation preview
COMMENTS ON MV Regargitation Surgery
Sotirios Prapas, MD, FECTS
MITRAL APPARATUS FUNCTION
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
The Mitral Apparatus function is based on interaction of 3
components, which are shaped as letter
“J”.
Pathology: Non functional MV
Regurgitation, Dilated Cardiomyopathy.
MITRAL APPARATUS PATHOLOGY
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
COMPONENTS: A) LEAFLETS & ANNULUS
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
MITRAL APPARATUS PATHOLOGY
Pathology: Post Ischemic
Mitral Valve Regurgitation.
COMPONENTS: B) LV WALL
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
COMPONENTS:
C) PAPILLARY MUSCLES
Pathology:
Post Ischemic
Papillary Muscle interruption.
MITRAL APPARATUS PATHOLOGY
Νormal
Degenerative
Reumatic
Endocarditis
MITRAL APPARATUS PATHOLOGY
A) NON FUNCTIONAL MITRAL
REGURGITATION
➢ The disease comes first, the regurgitation follows.
SURGERY
SURGERYTECHNIQUES for degenerative pathologies
Quadrantectomy Chords
Rings
P2 P3P1
P2P3P1 X
XXX
XX
LP
A
B
Scallops suture when chords are Scallops suture when chords are elongatedelongated
Fig. 1
SURGERYU- Callafiore Technique
SURGERYTECHNIQUES for degenerative pathologies
U- Technique
November 2013 – October 2014 ►Multi-center Study ►103 patients ►Isolated PL prolapse : 83 ►Bileaflet prolapse: 20 ►Median sternotomy in 82 cases ►Small right thoracotomy in 20 cases ►Robotic approach in one case
AATS Mitral conclave, April 2015
► EF was 55±7%. ► Mean MR grade (1 to 4) was 3.7±0.5. ► There was one in-hospital death due to
pneumonia (1%). ► No patient showed systolic anterior motion.
RESULTS
► At discharge, mean EF was 54±8%. ►Mean MR was 0.2±0.3, with 4 patients showing
MR grade 1. ► At follow-up evaluation (82 pts at 1-11 months),
EF was 55 + 6 %, MR was 0.3+ 0.5. ► All patients who underwent non-sternotomy
approaches had no residual MR.
RESULTS
MITRAL APPARATUS PATHOLOGY
B) FUNCTIONAL (DILATED) MITRAL REGURGITATION
➢ The regurgitation comes first, the disease follows.
➢ Unilateral PM displacement is typically present when a scar involves the myo- cardium around the posterior PM with or without the PM itself.
UNILATERAL
Post Ischemic (IMR)
CAB + MVRepair + Stem Cells 11 Cases
Henry Dunant Hospital
CAB + MVRepair + Stem Cells 11 Cases
Henry Dunant Hospital
CAB + MVRepair + Cells + Ablation 1 Case
Henry Dunant Hospital
Preop
Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
Preop
C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
Preop Postop
C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
Ευχαριστώ…
Recommended