Normal leaflet motion (Carpentier type I)
In some patients annular dilatation contributes to mitral re-
gurgitation and requires correction with an annuloplasty ring.
Decreased leaflet motion (Carpentier type III)
This is the most difficult lesion to correct. It may require a
combination of leaflet augmentation using patches of peri-
cardium, and also elongation or replacement of any restricted
chordae. Restricted leaflet motion due to poor ventricular
function remains a particularly difficult problem to correct by
repair techniques.
Features which indicate a low chance of successful repair
These include:
- Rheumatic valvular disease
- Thickened valve leaflets
- Multiple mechanisms of valve dysfunction
- Extensive prolapse of both leaflets
- Commissural regurgitation
- Annular calcification
- Dissection of valve leaflets complicating endocarditis.
In general all valves that can be repaired should be, although
some patients may opt for valve replacement to avoid the
(small) risk of needing further surgery due to failure of the
repair. Because of the low operative risk, absence of the need for
anticoagulation and avoidance of the risks of prosthetic valve
endocarditis following valve repair, a further group of patients
may be offered valve repair at an early stage of their disease
where, on the balance of risks, valve replacement would not yet
be justified.
RReeffeerreenncceess
1 David TE, Omran A, Armstrong S et al. Long-term results of mitral
valve repair for myxomatous disease with and without chordal
replacement with expanded polytetrafluoroethylene sutures. J Thorac
Cardiovasc Surg1998; 111155 : 1279–85; discussion 1285–6.
2 Chitwood WR Jr. Mitral valve repair: an odyssey to save the valves! J
Heart Valve Dis1998; 77 : 255–61.