Chapter 78: Acquired Disease of the Mitral Valve

Farzan Filsoufi, Joanna Chikwe and David H. Adams
Pages 1207-1240

Excerpt:
“Mitral valve repair is the procedure of choice for correcting severe mitral regurgitation. The goals of valve repair include preservation of leaflet mobility, restoration of a large surface of coaptation, and stabilization of the results with a remodeling annuloplasty. Current surgical techniques allow surgeons to perform reconstructive surgery in almost all patients with mitral regurgitation, provided there is an adequate amount of pliable and mobile leaflet tissue. A systematic approach to reconstructive surgery include the determination of the exact mechanism of mitral regurgitation by intraoperative inspection and valve analysis; meticulous application of standard techniques of repair, including remodeling annuloplasty, and evaluation of the quality of repair by saline test and transesophagael echocardiography.”

Chapter 91: Ischemic Mitral Regurgitation

Anelechi C. Anyanwu, Lishan Aklog, David H. Adams
Pages 1429-1448

Excerpt:
“Ischemic mitral regurgitation is a leading cause of heart failure and mortality in patients with coronary artery disease. This chapter addresses the current concepts regarding the pathophysiology and treatment of this condition.

Carpentier's pathophysiologic triad is our preferred approach for defining ischemic mitral regurgitation. Most of the clinical literature on ischemic mitral regurgitation remains difficult to interpret because imprecise definitions are often applied, which leads to marked heterogeneity within and between patient populations. We feel strongly that a precise definition of ischemic mitral regurgitation according to the pathophysiologic triad is critical to the presentation of a relatively homogeneous group of patients for analysis and treatment.”