Repairing complex rheumatic mitral valve : Current advances

MP053 

Abstract Submission 

Taweesak Chotivatanapong (1), Piyawat Lerdsomboon (2)

(1) Central Chest Institute of Thailand, Meung, Nonthaburi, (2) Central Chest Institute of Thailand, Nonthaburi, NA

*Taweesak Chotivatanapong    -  Contact Me
Central Chest Institute of Thailand

Piyawat Lerdsomboon    -  Contact Me
Central Chest Institute of Thailand

*Taweesak Chotivatanapong    -  Contact Me
Central Chest Institute of Thailand

Repairing complex rheumatic mitral valve: Current advances
Taweesak Chotivatanapong, MD , Piyawat Lerdsomboon,MD
Central Chest Institute of Thailand, Nonthaburi,
*Vejthani Hospital, Bangkok,
THAILAND.

Abstract:
Rheumatic heart disease remains a big challenge for many part of the world globally. Although valve repair for rheumatic mitral valve has been successfully done with encouraging results. However, in late stage of rheumatic disease , mitral valve often is severely affected and badly changed. A truly challenging situation for repair.
Current approach for repairing this group of valve is aimed for virtual repair of the valve. Valve analysis is the crucial step for planning and choice of surgical techniques. The goals are to restore normal systolic and diastolic dynamics. Type I mobility of valve leaflets is a MUST. Both quantity and quality of valve tissues especially anterior leaflet is of paramount concern. Pliability of mitral valve leaflets and subvalvular structure are very important for normal mitral dynamics. Leaflet peeling is an integral part of rheumatic valve repair in current era. Fenestration along with papillotomy are effective to improve collateral flow as well as pliability of subvalvular structure. Chordal repair usually can be done successfully by either chordal transfer or neochordal implantation. Tissue repair can be accomplished by autologous or bovine pericardium or synthetic material depends on surgeon preference. Calcified mitral valve poses a real challenge for valve repair. Current understanding and improvement of techniques allows surgeon to successfully tacked this problem. Choice of valve ring is last but not least step for good outcome.

Conclusion: With better understanding of mitral complex and dynamics plus improvement of surgical techniques, complex rheumatic mitral valve repair can be fixed more with encouraging results.

Rheumatic Mitral Valve Disease