The Mount Sinai Hospital The Mitral Foundation

  • Video-atlas on minimally invasive mitral valve surgery-The David Adams technique.

    Javier Castillo, MD, Fred Milla, MD, Anelechi C. Anyanwu, MD, and David H. Adams, MD

    Median sternotomy has unquestionably evolved over recent decades. Modern sternotomy involves a 7-8 cm lower midline skin incision, tunneling of the subcutaneous tissues with subsequent creation of myocutaneous flaps, full sternotomy, and standard cardiopulmonary bypass techniques with c...

    November 01, 2013 | Annals of Cardiothoracic Surgery

  • Making the Diagnosis

    Essentially, all degenerative mitral valves are repairable. By matching echocardiographic findings to the appropriate surgical skill level required to consistently deliver a repair, valve replacement for degenerative mitral valve disease should be infrequent. Fig 1: Echocardiography with dopplerMost patients with mitral regurgitation remain asymptomatic for long periods ...

  • Mitral Valve Repair

    Interactive 3D mitral valveWhat is mitral valve repair?The preferred treatment for patients with mitral valve disease is repair of their native valve. This requires special expertise, but the advantages for the patient are significant and include improved life expectancy, avoidance of long-term anticoagulation (use of blood thinners), and better preservation of native heart function.We use various...

  • When to Consider Surgery

    When Dr. Eisenberg found out he needed mitral valve repair, he said "you go to the place where you'll have the best result." He chose to have Dr. Adams perform his operation. The decision to refer or accept a patient for mitral valve surgery is substantially different than for most other cardiac surgical operations. Unlike other structural cardiac diseases, completely asymptomatic patients at ver...

  • Understanding Degenerative Disease

    In the hands of reference mitral valve-repair surgeons, 95-100% of degenerative valves are repairable1,2, regardless of etiology; however, in the general cardiac surgical community, the repair rates are around 50%. In contrast to fibroelastic deficiency, Barlow's valves have more complex pathology and require advanced techniques to effect a repair.Mitral valve regurgitation is present when the val...

  • Barlow's Mitral Valve Disease

    Interactive 3D surgical simulation of a surgical repair of a mitral valve with excess tissue.If you've been diagnosed with Barlow's Disease, ask your surgeon about his or her expertise and repair rate for Barlow's valves, a degenerative form of mitral valve disease. Reference mitral repair surgeons (surgeons certified for their experience in mitral valve repair) can fix up to 95% of Barlow's valve...

  • Fibroelastic Deficiency

    Figure 1: Interactive simulation of mitral valve repair for Fibroelastic Deficiency.In contrast to Barlow’s disease, patients with mitral regurgitation due to fibroelastic deficiency have a lack of connective tissue as the pathological mechanism that triggers leaflet and chordal thinning and eventual chordal rupture1. Carpentier’s group characterized the typical findings in fibroelastic deficiency...

  • Indications for Surgery

    Figure 1: Comparison of observed and expected survival in patients in NYHA classes I-II (left) and classes III-IV (right) Factors determining timing of surgery for degenerative mitral regurgitation in the current American College of Cardiology and American Heart Association guidelines include symptoms, left ventricular (LV) ejection fraction (EF), LV end-systolic dimension (LV ESD), atrial fibrill...

  • Golden Rules

    (*) Reprinted from J Thorac Cardiovasc Surg, 61(1)Over three decades ago, Alain Carpentier, MD, PhD and colleagues1 summarized the “Golden Rules” of mitral valve repair into three basic principles: preserve leaflet mobility, restore a large surface of coaptation, and remodel the annulus. Still applicable today, these surgical tenets allow reconstructive surgery in almost all patients with mitral ...

  • Valve Analysis

    Figure 1: Segmental Valve Analysis Figure 2: Valves are examined for lesions and calcificationAfter exposure of the valve, it is essential to examine the entire mitral valve apparatus in order to plan the exact operative technique. The surgeon confirms the mechanism of mitral regurgitation identifying all lesions and dysfunctions. Reparative action to all lesions should ...