Mitral valve repair

AORN Journal,  Jan, 2007  by Margo Winters,  Pam Obriot

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[Ce] indicates that continuing education contact hours are available for this activity. Earn the continuing education contact hours by reading this article and talking the examination on pages 167-168 and then completing the answer sheet and learner evaluation on pages 169-170 You also may access this article online at http://www.aornjournal.org.

REFERENCES

(1.) Ho SY. Anatomy of the mitral valve. Heart. 2002;88(suppl 4):iv5-10.

(2.) Seifert PC. Cardiac Surgery Perioperative Patient Care St. Louis: Mosby; 2002.

(3.) Finkelmeier BA, Cardiothoracic Surgical Nursing. Philadelphia: Lippincott, Williams & Wilkins; 1995:21-22.

(4.) Thompson JM, McFarland GK, Hirsh JE, et al. Mosby s Clinical Nursing. St Louis: Mosby; 1986.

(5.) Walkes JM, Reardon MJ. Status of mitral valve surgery. Curr Opin Cardiol. 2004;19: 117-122.

(6.) Wells FC, Shapiro LM. Mitral Valve Disease. Oxford: Butterworth-Heinemann, Ltd; 1996.

(7.) Nowicki ER, Weintraub RW, Birkmeyer NJ, et al. Mitral valve repair in northern New England. Am Heart J. 2003;145:1058-1062.

(8.) Savage EB, Bolling SF. Atlas of Mitral Valve Repair. Philadelphia: Lippincott, Williams & Wilkins; 2006.

(9.) Woo YJ, Nacke EA. Robotic minimally invasive mitral valve reconstruction yields less blood product transfusion and shorter length of stay. Surgery. 2006;140:263-267.

SIDEBAR

Systolic Anterior Motion

Systolic anterior motion (SAM) may occur when a relatively large posterior mitral valve leaflet [that is coapting] with the anterior mitral valve leaflet closer to its base [causes] both an anterior shift of the coaptation point and an increase in the amount of redundant leaflet tissue in the left ventricular outflow tract. (1)(p179)

Lee et at (2) reported that the incidence of SAM after mitral valve repair is 1% to 2%. More recently, Sternik and Zehr (3) reported the incidence of SAM to be 4% to 5%. Often, SAM is noted after the mitral repair is complete and separation from cardiopulmonary bypass (CPB) is initiated. Walkes and Reardon (4) assessed patients for SAM via TEE after separation from CPB. Performing an intraoperative transesophageal echocardiogram (TEE) provides a mechanism for diagnosing this phenomenon.

Correction of SAM often requires reestablishing CPB and resecting the redundant anterior leaflet tissue in the left ventricular outflow tract. Several preventative surgical techniques have been suggested to prevent the need for an additional episode of CPB. Sternik and Zehn (3) advocate tethering the mid segment of the anterior leaflet to prevent the leaflet from flipping into the left ventricular outflow tract. Quigley (1) suggests using an elliptical excision of the body of the anterior mitral valve leaflet and simple closure, thus reducing the height of the anterior mitral valve leaflet by approximately 5 cm.

If SAM is observed, ionotropic agents and volume loading are instituted to reduce after-load. The TEE is then repeated. If SAM is still observed, CPB is again established and the initial repair is reexamined.