Intraoperative Assessment of the Reconstructed Mitral Valve Using a Low Pressure Crystalloid Infusion

Abstract

A technique to intraoperatively assess mitral valve function after reconstruction is described. Cold cardioplegic solution is infused into the left ventricle at low intraventricular pressure (less than 15 mm-Hg) via the cardioplegia infusion line. The infusion of a crystalloid solution, instead of blood, clearly demonstrates residual leaks. Additional pump lines are not required and hypothermic cardioplegic arrest is maintained, thus allowing for repeated testing and additional repair. In combined aortic and mitral valve procedures, a Foley catheter is used to seal the aortic annulus and to infuse the crystalloid solution into the left ventricle. This method has been found to simplify mitral valve testing after reconstruction in a series of 25 patients since September 1979. Testing prompted additional repair in 4 patients and subsequent valve replacement in 2 patients.

Abnormal Accessory Mitral Leaflet Simulating Left Ventricular Outflow Tract Tumor

“…lnserting a Fo ley catheter into th e LV outflow through the aor tic incision in order to close the outflow tract wit h th e balloo n, mitral valve competen ce was tested by pressure inf usion of cardioplegic solution into the left ven tride thr ough the catheter (8) .…”

Intraoperative Evaluation of Reconstruction of the Atrio ventricular Valves by Transesophageal Echocardiography

“…To avo id co mplete im mobilisatio n of the annu lus ann ulopla sry wit b the Carpe ntier-ring w as not performed. Aft er recon stru ctio n rhe valve co mpetence wa s proved by rhe su rgeo n either by filling the no nbea tin g ventricle wirh saline solur ion and /or with low flow retro grade card io plegic so lution acco rding to the merhod described b y Hetzer (6).…”