Transcript
- Slide 1
- Mitral valve repair
- Slide 2
- Anatomy
- Slide 3
- Slide 4
- 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.
- Slide 5
- Pathophysiology High pressure in left atrium and lungs. Increase work of right ventricle. Atrial fibrillation. (palpitations) Stroke.
- Slide 6
- Causes of Mitral Stenosis Rheumatic fever. Congenital.
- Slide 7
- Rheumatic fever Immune complexes. (Strep throat/ renal infections) Slow process. Repeated attacks. Replacement.
- Slide 8
- Indication for surgery Valve opening area < 1.5 cm sq. Gradient > 12mmHg.
- Slide 9
- Slide 10
- Mitral Incompetence Valve does not close properly. Blood flows back into the left atrium. Volume overload of left ventricle. Left ventricular failure.
- Slide 11
- Aetiology Rheumatic Fever. Endocarditis Barlow's syndrome. (Floppy valve) Ischemia. Congenital. Cardiomyopathy.
- Slide 12
- 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
- Slide 13
- Surgery General anaesthesia. TEE on board. Cardio-pulmonary bypass. Cell saver. Repair before replace.
- Slide 14
- Type 1: Annulus dilatation
- Slide 15
- Remodelling annuloplasty
- Slide 16
- Slide 17
- Type 2 Valve prolapse To much thickened leaflet. Stretched out chordae. Elongated papillary muscles. Leaflet prolaps.
- Slide 18
- Mitral valve segments
- Slide 19
- Quadrangular excision repair
- Slide 20
- Slide 21
- TEE- Post repair
- Slide 22
- Slide 23
- Triangular excision repair
- Slide 24
- Artificial chordoplasty
- Slide 25
- Artificial chordoplasty and cleft repair
- Slide 26
- Type 3a- Rheumatic valves
- Slide 27
- 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.
- Slide 28
- Slide 29
- Mitral valve replacement Native valve removed. Mechanical or Tissue prosthesis.
- Slide 30
- Mechanical prosthesis
- Slide 31
- Tissue prosthesis
- Slide 32
- Mechanical mitral valve replacement Surgical mortality 2% - 4% Bleeding risk 1%/year Thrombo-embolism 1%/year Endocarditis 0.1%/year
- Slide 33
- Clotted mitral valve
- Slide 34
- Pannus ingrowth
- Slide 35
- Minimally invasive mitral surgery
- Slide 36
- The future- Robotic surgery
