SURGICAL TREATMENT FOR MITRAL VALVE DISORDERS

Mohammad Shihata

Anatomy

Diastole Systole

Anatomy

Mitral Annulas

Anterior Leaflet

Posterior Leaflet

Chordae

Papillary Muscles

Left Ventricle

Normal MV

Anatomy

Anatomy

Echocardiography

Mitral Stenosis

Rheumatic Heart Disease Severe Degenerative Calcification Congenital LA Myxoma Carcinoid Supramitral Ring

Mitral Stenosis

Mitral Stenosis Normal

Clinical Picture

Asymptomatic

Chest Pain

Shortness of Breath

Thromboembolic complications

Atrial Fibrillation

Mitral Regurgitation

(MVP) Myxomatous Degenerative ( Annular Calcification ) Endocarditis Ischemic

Congenital Acute Rheumatic Heart Disease

Functional Classification of MR

Guidelines

PMBV

Anticoagulation in Mitral Stenosis Atrial Fibrillation

Previous embolic event

Left Atrial Thrombus

Severe MS ; LA > 55mm

Indications for Surgery in MS Symptomatic and gradient > 10mm Hg

CHF NYHA 2 – 3

Associated moderate to severe MR

Unavailable or Unsuccessful PBMV

LA thrombus

Asymptomatic with Severe PAH

Surgical Indications in Severe MR Symptomatic Severe MR Asymptomatic Severe MR LVEF < 60% LVESD > 40mm Pulmonary HTN New Onset Atrial Fibrillation Congenital Abnormality of the valve

apparatus

Repair vs. Replacement

> 80% of regurgitant Mitral valves are repairable

Repair produces more physiological flow states

It better preserves LV function

Less thromboembolic events

Long durability

Lower risk of Endocarditis

Surgical Approach

Everest II Trial

Randomized Arm High Risk Registry Arm

This study arm compares the E-valve PMR procedure to

the current standard of care, mitral valve surgery.Initiated in late 2005, this arm will enrol

approximately300 patients.

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