This document discusses surgical treatments for mitral valve disorders such as mitral stenosis and mitral regurgitation. It outlines the anatomy of the mitral valve and describes common causes of mitral stenosis and regurgitation. Guidelines for indications of surgery are provided for both conditions, noting that symptoms, hemodynamics, complications and valve anatomy/repair potential should be considered. Surgical techniques for mitral valve repair and replacement are briefly covered.

1. SURGICAL
TREATMENT FOR
MITRAL VALVE
DISORDERS
Mohammad Shihata

2. Anatomy

3. Diastole Systole

4. Anatomy
 Mitral Annulas
 Anterior Leaflet
 Posterior Leaflet
 Chordae
 Papillary Muscles
 Left Ventricle

5. Normal MV

6. Anatomy

7. Anatomy

9. Echocardiography

10. Mitral Stenosis
 Rheumatic Heart Disease
 Severe Degenerative Calcification
 Congenital
 LA Myxoma
 Carcinoid
 Supramitral Ring

11. Mitral Stenosis

12. Mitral Stenosis Normal

13. Clinical Picture
 Asymptomatic
 Chest Pain
 Shortness of Breath
 Thromboembolic complications
 Atrial Fibrillation

14. Mitral Regurgitation
 (MVP) Myxomatous
 Degenerative ( Annular Calcification )
 Endocarditis
 Ischemic
 Congenital
 Acute Rheumatic Heart Disease

15. Functional Classification of
MR

16. Guidelines

18. PMBV

20. Anticoagulation in Mitral
Stenosis
 Atrial Fibrillation
 Previous embolic event
 Left Atrial Thrombus
 Severe MS ; LA > 55mm

21. 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

22. 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

24. 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

25. Surgical Approach

32. 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
approximately
300 patients.