Mitral Valve

Question 1

Describe MV repair

Answer 1

Small triangular resection of posterior leaflet and sliding annuloplasty to posterior leaflet t reduce height of leaflet

Gor-Tex chords from papillary to anterior leaflet, sizing chords based upon secondary chords, ensuring leaflet not above plane of valve

Annuloplasty and secure with full ring

Test valve with static testing with antegrade plegia

Close atrium with LV vent across valve

Once minimal air, remove LV vent and wean off CPB

TEE

Question 2

Hypokinesis of lateral wall after MVR. How to address?

Answer 2

Worried about circumflex occlusion. Place vein graft to circ

Ensure good function when weaning off CPB, may need IABP given lateral wall ischemia and longer XC

Question 3

Bright blood behind heart when weaning off CPB after MVR?

Answer 3

Concern about AV groove disruption

Return on CPB, remove valve, repair ventricle from within with pericardial patch, reinsert mechanical valve