Intraoperative assessment of mitral valve competence: a safe and reliable technique.
OBJECTIVE
In mitral valve (MV) reconstructive surgery, the most difficult problem is immediate, intraoperative assessment of the repaired valve. We describe a simple technique of assessing the MV after the repair while the left atrium (LA) is still open.


METHODS
The heart is perfused through a coronary line, after frustrating the MV with a multiholed disposable chest tube, and made to beat while the aorta is declamped. After de-airing, the frustrator is removed and the coronary line flow is gradually increased to one third of the arterial pump output. Within the blood filled pericardial well, through the opened LA, the MV is assessed for competence. The method allows for taking any corrective steps to achieve a competent MV before proceeding further.


RESULTS
Over the last 10 years, the method was used in 106 patients undergoing MV repair. It allowed us to take corrective steps in all 31 patients (29.2%) who were found to have significant mitral regurgitation. No complication which could be attributed to the method of testing was documented.


CONCLUSIONS
The method is found to be simple, safe, reliable, and has ensured against accepting less than optimal results.
Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College and Hospital, Manipal, India.
P
P
Shatapathy
B K
BK
Aggarwal
D017548:Echocardiography, Transesophageal; D006801:Humans; D007432:Intraoperative Period / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome