MITRAL VALVE REPLACEMENT
- Optimally started by a short incision at the base of the AML at the 12 o'clock position
- A pledgeted mattress stitch is placed into the mitral annulus at the point of incision then using it to pull the annulus into the operative field.
- AML is then circumferentially incised as far as the commissures
- Chordae are divided at the tip of the papillary muscles.
- PML is left intact preserving the ventriculo-annular continuity.
- In MS with suitable morphology.
- In MR unsuitable for repair with a dilated severely impaired LV.
Advantages of PML Preservation:
Partial preservation of the AML and commissural fixation with preservation of PML
Mattress sutures placement into the mitral annulus with pledgets on supraannular side
- Interrupted pledgeted mattress stitches are commonly used.
- In a well-accessible firm annular tissue, a continuous stitch may be used.
- Bileaflet prosthesis are positioned anti-anatomically (slit between the two leaflets is orientated perpendicular to the coaptation zone of of AML and PML) for optimal haemodynamics.
Excessive Annular Calcifications:
Atrioventricular Groove Disruption: