Mitral Valve Repair

An Example of Mitral Valve Repair

This patient is a 55 year old female who was treated for mitral valve endocarditis (infection of the mitral valve) approximately 20 years ago.  She has had a mitral valve murmur secondary to mitral regurgitation ever since.  She was recommended  to have mitral valve surgery over the years, but refused.  Eventually, she became so limited because of shortness of breath that she finally agreed to surgery.

Below is a view of the outside of her heart.  The large blue structure is the right atrium which in this case is massively dilated, approximately three times the normal size.  The yellow structure with blood vessels going across it is the right ventricle, also severely enlarged.

Below the right and left atria are opened exposing the mitral valve. The posterior leaflet is torn. The torn portion is being held by a surgical hook. I will excise the torn portion and repair the leaflet.Below the leaflets are repaired.  I now have placed sutures around the edges of the valve(the mitral annulus). These sutures will be placed through a ring (annuloplasty ring) that will support the repaired leaflets.Below is the completed repair.  The leaflets are sewn back together and the repair is supported by an annuloplasty ring.  The patient did very well.  She no longer has any leaking of her mitral valve and has returned to a normal, very active quality of life.

Below are some videos illustrating
the techniques shown above:

In this video, you can see the valve being analyzed to determine what needs to be done to the leaflets.

In this video we're cutting out the "flail" portion of the posterior mitral leaflet.

Here we've place sutures to repair the leaflet and now we're placing more sutures to implant the annuloplasty ring.

In this final video, we're placing the sutures into the annuloplasty ring followed by securing the ring in place around the mitral valve repair.  This particular ring is known as a "flexible" ring.  Annuloplasty rings come in different makes and sizes.  I now more typically use a semi-rigid ring.