The Mount Sinai Hospital The Mitral Foundation

  • 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 ...

  • Posterior Leaflet Prolapse

    Figure 1: Posterior leaflet quadrangular resection, annular plication.Posterior leaflet prolapse due to fibroelastic deficiency is most commonly treated by a resection of the prolapsed segment affected by chordal rupture (Figure 1). The prolapsed segment is removed by excising a quadrangular portion of the leaflet. The posterior annulus is then vertically plicated by placing and tying several sut...

  • Anterior Leaflet Prolapse

    Figure 1: Anterior leaflet triangular resectionUnlike the posterior leaflet, aggressive resection of the anterior leaflet margin is not feasible due to anatomic constraints. Therefore the strategies employed for anterior leaflet prolapse are designed to correct prolapse without resection of significant areas of leaflet tissue. Very limited prolapse of the anterior leaflet can be treated by a small...

  • Remodeling the Annulus

    Figure 1: Annular remodelingAfter addressing the prolapsing segments in the anterior and/or posterior leaflet, attention then turns to restoring normal annular geometry (Figure 1). The normal ratio between the antero-posterior (septo-lateral) and transverse diameter of the mitral annulus is approximately 3:4 during systole. This ratio inverts in patients with chronic mitral regurgitation resulting...

  • Minimally Invasive Heart Surgery

    We have helped pioneer small access incision valve surgery. We will always make the smallest possible incision for safe and efficient surgery. In general, incisions are normally closed with stitches beneath the skin that dissolve in 2-3 months, minimizing visual scar tissue.Mitral valve repair is the gold standard procedure for patients who require surgery for mitral valve disease1. This is partic...