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J Thorac Cardiovasc Surg 2008;135:1320-1321
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr John J. Lamberti (San Diego, Calif). I compliment Dr Oppido for his excellent presentation. Oppido and colleagues have analyzed their experience in repairing anatomic mitral valves. Seventy of 71 patients underwent successful valve repair, with a relatively small percentage returning for early re-repair. In general, I agree with their indications for surgery and many of the technical details described in the article.

Oppido and colleagues favor exposure through a conventional left atriotomy. I prefer the transseptal approach, and I have a very low threshold for extending my incision into the dome of the left atrium, thereby creating optimal exposure of the valve, especially in small patients. Intraoperative valve testing requires that the valve be undistorted while static testing is taking place.

Dr Oppido didn't mention in his presentation, but transesophageal echocardiography was used in about 87% of their cases. We rely heavily on the postrepair transesophageal echocardiography in determining whether our repair is adequate. In complex repairs, we recommend performing a preliminary transesophageal echocardiogram after recovery of the myocardium has occurred but not necessarily before full rewarming has been completed. In about 10% of patients, we may go back to bypass and make adjustments to the repair. This approach allows fine-tuning of the repair. We always place a left atrial pressure monitoring catheter before separation from bypass. The postrepair analysis must be performed under optimal loading conditions if we are to make inferences about the quality and durability of the repair.

Most of the early reoperations in Oppido and colleagues' series occurred in patients younger than 1 year. Only 87% of the patients underwent transesophageal echocardiography at the time of the first repair. In our experience, analysis of the repair in the operating room is very important in predicting short- and long-term outcomes. When a patient is too small . . . [Full Text of this Article]

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Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy

Guido Oppido, Ben Davies, D. Michael McMullan, Andrew D. Cochrane, Michael M.H. Cheung, Yves d'Udekem, and Christian P. Brizard
J. Thorac. Cardiovasc. Surg. 2008 135: 1313-1321. [Abstract] [Full Text] [PDF]