Chapter 74: Acquired Disease of the Mitral Valve Farzan Filsoufi, Sacha P. Salzberg, Lishan Aklog, David H. Adams
Pages 1299-1334

Excerpt: “Mitral valve repair is the procedure of choice for correction of severe mitral regurgitation. The goals of valve repair include preserving leaflet mobility, restoring a large surface of coaptation, and stabilizing the results with a remodeling annuloplasty. Current surgical techniques allow surgeons to perform reconstructive surgery in almost all patients with mitral regurgitation, provided there is an adequate amount of pliable and mobile leaflet tissue. A systematic approach to reconstructive surgery include the determination of the exact mechanism of mitral regurgitation by intraoperative inspection and valve analysis; meticulous application of standard techniques of repair, including remodeling annuloplasty; and evaluation of the quality of repair by saline test and TEE.”

Chapter 86: Ischemic Mitral Regurgitation Lishan Aklog, Farzan Filsoufi, David H. Adams
Pages 1525-1548

Excerpt: “Patients with type I or IIIB ischemic MR typically present with one of two clinical scenarios. The more common scenario is a patient with symptomatic multivessel coronary artery disease, with or without associated congestive heart failure symptoms, who is referred for surgical or percutaneous revascularization and who is noted to have mild to moderate MR on preoperative echocardiography or ventriculography. The other scenario is a patient with moderate to severe MR and primarily congestive heart failure symptoms who is referred for mitral valve surgery and who is noted to have multivessel coronary artery disease on preoperative catheterization. We have proposed a set of criteria to use to define ischemic MR. Some of the clinical literature about ischemic MR is difficult to interpret because of imprecise definitions that lead to etiological and physiological heterogeneity within the patient population. We feel strongly that a relatively simple-but precise-definition of ischemic MR is critical to the presentation of a relatively homogenous group of patients for analysis.”