Author + information
- Jocelyn N. Spoon, MD∗∗ (, )
- Vuyisile T. Nkomo, MD, MPH∗∗∗ (, )
- Rakesh M. Suri, MD, DPhil†,
- Sorin V. Pislaru, MD, PhD∗,
- Daniel B. Spoon, MD∗,
- Hector I. Michelena, MD∗,
- Maurice E. Sarano, MD∗ and
- Joseph F. Malouf, MD∗
- ∗Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- †Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
Mitral valve repair is the treatment of choice for mitral regurgitation secondary to myxomatous degenerative valve disease given the associated low operative mortality and excellent long-term survival. Recurrent mitral valve dysfunction requiring reoperation following primary valve repair is uncommon, especially when performed by experienced surgeons at high-volume centers. The most common etiology of recurrent regurgitation after repair is progressive degeneration of the valvular apparatus, including new leaflet prolapse or flail. Less common mechanisms for repair failure can be categorized as procedural or technical failures and include annuloplasty dehiscence, leaflet suture rupture, incorrect artificial chord length, and incorrect annuloplasty position. Determining etiology of primary repair failure provides essential information regarding candidacy for re-repair, which is associated with superior outcomes over valve replacement (1). Our aim is to provide an echocardiography-based imaging guide to help evaluate patients presenting with recurrent mitral valve dysfunction following repair. We have included 8 total illustrative cases (Figures 1, 2, 3, 4, 5, and 6).
Determination of the mechanism of mitral valve dysfunction following mitral valve repair is paramount and can be done reliably with echocardiography. Two-dimensional and 3-dimensional transesophageal echocardiography should be performed in all cases of recurrent mitral valve dysfunction because of superior spatial resolution and anatomic detail when compared with transthoracic echocardiography.
The authors thank Mark A. Zangs for his time and expertise in image construction, as well as Dr. William D. Edwards for his expert review.
Dr. Suri has received research funding from Sorin, Abbott, Edwards Lifesciences, and St. Jude Medical; is a member of the board of Abbott (COAPT Trial Clinical Steering Committee) and St. Jude Medical (Portico Trial Steering Committee); and is a consultant for Sorin (Perceval trial national principal investigator) and Abbott (COAPT trial co-principal investigator). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.