- There are many ways to skin a cat!. I don’t believe that in Mitral Valve Repair there exists one technique to repair all valves. It needs to be individualized to the specific pathology that one encounters as well as to the repair techniques that one feels comfortable performing. You definitely need to have
a toolbox of techniques. I have encountered several Barlow’s valves that have an extremely tall posterior leaflet, that is as tall or taller that the anterior leaflet. I have found the inversion folding- plasty to be useful in this particular instance. This is performed via a minimally invasive platform (right mini thoracotomy). I believe that the visibility of the valve is more anatomical and direct, despite being further away. It is imperative to develop a comfort level with the long shafted instruments. The technique consists of placing all of the annular sutures first. Careful inspection of the valve and its prolapsed segments. Placing 4-0 prolene sutures in a mattress fashion, 2-3 mm from the free edge of the posterior leaflet. The suture is then directed under the leaflet (on the ventricular side) and is exited on the annulus. This creates a leaflet that is one half of the original size. As many sutures are placed to establish a uniform posterior leaflet or “door stop”. The valve ring is sized for the anterior leaflet. Once the annualar sutures are tied down, the prolene sutures are placed through and tied to the ring. This will avoid the sutures tearing through the annulus.
I have enclosed pictures to demonstrate the technique