After 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 result in a competent valve. The endocardium of the left atrium is examined for jet lesions, which indicate opposite leaflet prolapse or same side leaflet restriction. The mitral annulus is examined to assess the severity of annular dilatation and the presence or absence of calcification. The valvular apparatus is then examined in order to assess tissue pliability and to identify leaflet prolapse or restriction according to segmental valve analysis. After identifying a non-prolapsing segment (the anterior paracommissural scallop of the posterior leaflet [P1] is least often prolapsed in patients with degenerative disease), other valvular segments are compared to the reference segment to determine the extent of leaflet prolapse or restriction.
* Modified from Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. From Valve Analysis to Valve Reconstruction. 2010 Saunders Elsevier.