Mitral and Tricuspid Valve Operative Techniques
The complexity of the mitral valve and the fact that it can be afflicted by multiple pathologies means that the expert mitral surgeon must be practiced in a wide variety of surgical techniques. The most common lesion giving rise to mitral regurgitation is posterior leaflet prolapse, usually affecting the central P2 scallop. A potential mistake is to think that these are always simple and repair can follow a standard protocol. Whilst this may be true for many such valves, it is not uncommon to find secondary and tertiary lesions in these valves. Therefore, it is important to be flexible in approach and have a number of surgical options that can be utilised. For more complicated lesions, such as bi-leaflet prolapse, particularly the Barlow’s valve, it is essential for the surgeon to be able to draw upon several surgical solutions to allow the best outcome. The rheumatic valve sets its own challenges and whilst prosthetic valve replacement is a very good option for most patients, a significant number of valves may be reconstructed. In the younger age group, especially women who may wish to become pregnant, reconstruction, if it can be performed well, is an excellent option. Another group in which reconstruction is commonly achievable are patients with endocarditis. Here, it is vital to debride all infected tissue prior to reconstruction. This will mean that the full range of surgical techniques may be required.