Role of echo in surgery for mitral regurgitation

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Role of echo in surgery for mitral regurgitation

Ischemic mitral regurgitation (MR)

Measurements: Tenting height or coaptation depth, tenting area, posterior leaflet tenting, anterior leaflet tenting, tenting angle of anterior and posterior leaflets are some of the measures. Tethering is because an infarcted posterior wall expands and pulls the papillary muscle distally.

Addressing moderate MR in the setting of CABG:

Presence of more than 5 viable ischemic segments predict improvement of MR with coronary artery bypass grafting (CABG) alone, without mitral valve repair. Dyssynchrony between papillary muscles can be detected by tissue Doppler and predicts response to CABG.

Carpentier functional classification: Types I to III; modified Carpentier classification: Types I to V.

Methods of repair in MVP – MR:

Quadrangular leaflet resection in mitral valve prolapse (MVP) described by Carpentier, transfer of normal chords to other areas, artificial polytetrafluoroethylene (PTFE) chords to replace diseased or deficient chords, edge to edge repair with annuloplasty and non-resectional repair of Barlow are some of the methods.