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Intraoperative Classification of Mitral Valve Dysfunction: The Role of the Anesthesiologist in Mitral Valve Reconstruction

      ANESTHESIOLOGISTS cannot concentrate solely on advances made within the specialty, but must also keep up with developments occurring within the field of surgery because the surgical management of the patients partly determines the anesthetic management. Mitral valve disease and its surgical therapy represent a very dynamic area within the field of cardiac surgery. Thanks to better understanding of the anatomy of the mitral valve apparatus, pathophysiology of underlying disease processes, and improvements in surgical technique, a shift has taken place clearly favoring mitral valve repair over mitral valve replacement for regurgitant lesions.
      • Sand M.E.
      • Naftel D.C.
      • Blackstone E.H.
      • et al.
      A comparison of repair and replacement for mitral valve incompetence.
      • Goldman M.E.
      • Mora F.
      • Guarino T.
      • et al.
      Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function; an intraoperative two-dimensional echocardiographic study.
      Despite this shift in surgical philosophy, as reflected in the 2006 guidelines published by the American Heart Association/American College of Cardiology (AHA/ACC), repair rates for mitral valve regurgitation continue to languish around 50% in the United States and Europe,
      • Savage E.B.
      • Ferguson Jr, T.B.
      • DiSesa V.J.
      Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database.
      • Iung B.
      • Baron G.
      • Butchart E.G.
      • et al.
      A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.
      even though numerous reports have shown that mitral valve repair is durable and has superior long-term survival rates when compared with mitral valve replacement.
      • De B.M.
      • Lorusso R.
      • Lapenna E.
      • et al.
      Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse.
      • David T.E.
      • Ivanov J.
      • Armstrong S.
      • et al.
      A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.
      • Gillinov A.M.
      • Cosgrove D.M.
      • Blackstone E.H.
      • et al.
      Durability of mitral valve repair for degenerative disease.
      • Adams D.H.
      • Anyanwu A.
      • Rahmanian P.B.
      • et al.
      Larger annuloplasty rings facilitate mitral valve repair in Barlow's syndrome.

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      References

        • Sand M.E.
        • Naftel D.C.
        • Blackstone E.H.
        • et al.
        A comparison of repair and replacement for mitral valve incompetence.
        J Thorac Cardiovasc Surg. 1987; 94: 208-219
        • Goldman M.E.
        • Mora F.
        • Guarino T.
        • et al.
        Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function; an intraoperative two-dimensional echocardiographic study.
        J Am Coll Cardiol. 1987; 10: 568-575
        • Savage E.B.
        • Ferguson Jr, T.B.
        • DiSesa V.J.
        Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database.
        Ann Thorac Surg. 2003; 75: 820-825
        • Iung B.
        • Baron G.
        • Butchart E.G.
        • et al.
        A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.
        Eur Heart J. 2003; 24: 1231-1243
        • De B.M.
        • Lorusso R.
        • Lapenna E.
        • et al.
        Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse.
        J Thorac Cardiovasc Surg. 2006; 131: 364-370
        • David T.E.
        • Ivanov J.
        • Armstrong S.
        • et al.
        A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.
        J Thorac Cardiovasc Surg. 2005; 130: 1242-1249
        • Gillinov A.M.
        • Cosgrove D.M.
        • Blackstone E.H.
        • et al.
        Durability of mitral valve repair for degenerative disease.
        J Thorac Cardiovasc Surg. 1998; 116: 734-743
        • Adams D.H.
        • Anyanwu A.
        • Rahmanian P.B.
        • et al.
        Larger annuloplasty rings facilitate mitral valve repair in Barlow's syndrome.
        Ann Thorac Surg. 2006; 82: 2096-2100
      1. Practice Guidelines for Perioperative Transesophageal Echocardiography: A Report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.
        Anesthesiology. 1996; 84: 986-1006
        • Carpentier A.
        Cardiac valve surgery—The “French correction”.
        J Thorac Cardiovasc Surg. 1983; 86: 323-337
        • Anyanwu A.C.
        • Adams D.H.
        The intraoperative “ink test”: A novel assessment tool in mitral valve repair.
        J Thorac Cardiovasc Surg. 2007; 133: 1635-1636
        • Salgo I.S.
        • Gorman 3rd, J.H.
        • Gorman R.C.
        • et al.
        Effect of annular shape on leaflet curvature in reducing mitral leaflet stress.
        Circulation. 2002; 106: 711-717
        • Shanewise J.S.
        • Cheung A.T.
        • Aronson S.
        • et al.
        ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
        Anesth Analg. 1999; 89: 870-884
        • Aklog L.
        • Filsoufi F.
        • Flores K.Q.
        • et al.
        Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation?.
        Circulation. 2001; 104: I68-I75
        • Smith M.D.
        Evaluation of valvular regurgitation by Doppler echocardiography.
        Cardiol Clin. 1991; 9: 193-228
        • Grayburn P.A.
        • Fehske W.
        • Omran H.
        • et al.
        Multiplane transesophageal echocardiographic assessment of mitral regurgitation by Doppler color-flow mapping of the vena contracta.
        Am J Cardiol. 1994; 74: 912-917
        • Enriquez-Sarano M.
        • Seward J.B.
        • Bailey K.R.
        • et al.
        Effective regurgitant orifice area: A noninvasive Doppler development of an old hemodynamic concept.
        J Am Coll Cardiol. 1994; 23: 443-451
        • Klein A.L.
        • Obarski T.P.
        • Stewart W.J.
        • et al.
        Transesophageal Doppler echocardiography of pulmonary venous flow: A new marker of mitral regurgitation severity.
        J Am Coll Cardiol. 1991; 18: 518-526
        • Adams D.H.
        • Anyanwu A.C.
        • Sugeng L.
        • et al.
        Degenerative mitral valve regurgitation: surgical echocardiography.
        Curr Cardiol Rep. 2008; 10: 226-232
        • Braun J.
        • van de Veire N.R.
        • Klautz R.J.
        • et al.
        Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure.
        Ann Thorac Surg. 2008; 85: 430-436
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • et al.
        American Society of Echocardiography: Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • O'Gara P.
        • Suggeng L.
        • Lang R.
        • et al.
        The role of imaging in chronic degenerative mitral regurgitation.
        J Am Coll Card Imaging. 2008; 1: 221-237
        • Brown M.L.
        • Abel M.D.
        • Click R.L.
        • et al.
        Systolic anterior motion after mitral valve repair: Is surgical intervention necessary?.
        J Thorac Cardiovasc Surg. 2007; 133: 136-143
        • Yamauchi T.
        • Taniguchi K.
        • Kuki S.
        • et al.
        Evaluation of the mitral valve leaflet morphology after mitral valve reconstruction with a concept “coaptation length index”.
        J Card Surg. 2005; 20: 432-435