Mitral valve repair was one of the first operations performed on the heart. In 1923 Elliot Cutler performed a successful valvotomy for mitral stenosis.1 Though this was a destructive rather than a reconstructive procedure, it nevertheless is the first representation of the concept behind mitral valve repair—to use the patients own valvular tissue to create a functional, durable treatment for the affecting disease process. When valve prostheses were developed the surgeon's attention was temporarily diverted from repair. Prostheses were easier to place and required less ischemic time. However, the early enthusiasm for bioprostheses was tempered by their limited life span. Enthusiasm for mechanical prostheses was tempered by the requirement for anticoagulation. A few pioneers continued to develop and refine techniques and demonstrated that repair led to lower failure rates with a lower incidence of thromboembolism, hemorrhage, and infection. Despite this repair is probably underutilized by U.S. surgeons.2
This book was conceived to foster and promote the application of repair techniques in mitral surgery. Because busy surgeons do not have much spare time we aimed for brevity. The stated goal at the outset was not to recommend, but instead to review and assess the wide variety of techniques surgeons have applied over the years to treat different problems. The book is organized based on techniques that address problems with specific valve components, attempting to present a number of solutions for similar problems. Since static diagrams often do not transfer well to the operating room we have included six complete annotated videos to supplement the text. However, unlike many video presentations, we have broken these up into specific segments with references within the text. We have included certain images from the video in the text to emphasize key points.
For surgeons who perform mitral repair we hope this will be a nice review and perhaps add some new techniques to your armamentarium. For those just beginning to learn we hope this provides a suitable roadmap for your journey.
For surgeons who perform mitral repair we hope this will be a nice review and perhaps add some new techniques to your armamentarium. For those just beginning to learn we hope this provides a suitable roadmap for your journey.
Edward B. Savage and Steven F. Bolling
Book Features
- Full-color atlas with accompanying video DVD provides a complete and practical "how-to" guide to planning and performing mitral valve repair surgery
- Explains preoperative use of echocardiography to identify the mitral valve defect and the necessary repair maneuvers
- Describes and illustrates all techniques currently used for mitral valve repair—annuloplasty, commissurotomy, anterior leaflet repair techniques, posterior leaflet repair techniques, commissural repair techniques, and other techniques
- Discusses results of each technique, assessment of the quality of repair, and complications
- Bound-in DVD presents narrated video clips of six cases that show the application of specific techniques. Each case includes preoperative echocardiographic evaluation, key surgical maneuvers, and testing of the repaired valve.
Contents
1. The Natural History of Mitral Regurgitation
2. Functional Anatomy of the Mitral Valve
3. Pathology of Mitral Valve Disease
4. Assessing the Functional Substrate of Mitral Regurgitation with Echocardiography
5. Overview of Mitral Valve Repair
6. Annuloplasty: Sutures, Bands and Rings
7. Commissurotomy
8. Anterior Leaflet Repair Techniques
9. Posterior Leaflet Repair Techniques
10. Commissural Repair Techniques
11. Other Techniques
12. Complications and Assessing the Quality of Repair
CONTENTS OF DVD
Case 1
- Clip 1. Preoperative echocardiogram with flail posterior leaflet and anterior jet with audio
- Clip 2. Examination of the posterior leaflet P2 flail chordal rupture and a cleft with audio
- Clip 3. Excision of a portion of the P2 Scallop based on the location of intact chords with audio
- Clip 4. Mobilization of the posterior leaflet and placement of posterior annuloplasty sutures with audio
- Clip 5. Reattachment of the posterior leaflet creating a posterior sliding plasty with audio
- Clip 6. Evaluation of cleft after posterior sliding plasty with audio
- Clip 7. Closure of cleft after posterior sliding plasty with audio
- Clip 8. Placement of remaining annuloplasty sutures with audio
- Clip 9. Sizing the annuloplasty band with audio
- Clip 10. Placement of sutures through the annuloplasty band with audio
- Clip 11. Final test after band placement with audio
- Clip 1. Angiogram demonstrating poor EF and severe MR with audio
- Clip 2. Echocardiogram demonstrating dilated annulus, tethered leaflets, poor coaptation
- Clip 3. Examination of the leaflets with audio
- Clip 4. Sizing the ring with audio
- Clip 5. Testing the valve after ring placement with audio
- Clip 6. Postoperative echocardiogram showing reduced annular diameter with audio
- Clip 1. Preoperative echocardiogram rheumatic valve with tethering, thickening, decrease excursion
- Clip 2. Evaluation of the leaflet stiff, commissural and cleft fusion, thickened chord with audio
- Clip 3. Release of secondary chordae with audio
- Clip 4. Commissurotomy with audio
- Clip 5. Sizing the annuloplasty band with audio
- Clip 6. Testing with cleft closure and lateral commissuroplasty with audio
- Clip 1. Preoperative echocardiogram anterior leaflet prolapse with posterior jet with audio
- Clip 2. Examination of anterior leaflet prolapse with audio
- Clip 3. Anchoring the PTFE suture in the papillary muscle with audio
- Clip 4. Placement of annuloplasty sutures with audio
- Clip 5. Selecting the size of the annuloplasty band with audio
- Clip 6. Medial commissuroplasty with audio
- Clip 7. Testing after medial commissuroplasty with audio
- Clip 8. Attachment of PTFE chord to anterior leaflet with audio
- Clip 9. Postoperative echocardiogram with audio
- Clip 1. Preoperative echocardiogram with audio
- Clip 2. Dissection of the interatrial groove with audio
- Clip 3. Evaluation of the valve with audio
- Clip 1. Evaluation of the valve with bileaflet prolapse and posterior stretched chords with audio
- Clip 2. Quadrangular resection of the P2 scallop of the posteior leaflet with audio
- Clip 3. Placement of PTFE suture in anterolateral papillary muscle with audio
- Clip 4. Posterior folding plasty with audio
- Clip 5. Securing the posterior leaflet with audio
- Clip 6. Attachment of PTFE sutures to anterior leaflet with audio
- Clip 7. Sizing the ring with audio
- Clip 8. Securing the ring with audio
Product Details
- Hardcover: 126 pages
- Publisher: Lippincott Williams & Wilkins; Har/Dvdr/C edition (2006)
- Language: English
- ISBN-10: 0781746922
- ISBN-13: 978-0781746922
- Product Dimensions: 11.1 x 8.5 x 0.5 inches