Role of Echocardiography in MV repair

Mitral regurgitation is the 2nd most common clinically significant form of valvular heart disease.2D, 3D, and Doppler echocardiography has a key role in assessment of the etiology, mechanism, severity, hemodynamic impact of the MR, timing and type of the surgery. 3D echocardiography assessments of mitral valve pathology should be incorporated into routine clinical practice as it provides en face view of the MV that is an orientation identical to the surgeon’s view and gives the best morphologic information of the MV anatomy and pathology, also helps identify the dominant lesion in patients with complex prolapse resulting from multisegment involvement or commissural lesions, presence of the MV cleft and assess the likelihood repair of the MV.MV repair is a category 1 indication for peri operating TEE which includes pre-cardiopulmonary and post-cardiopulmonary imaging.The purpose of pre-bypass assessment is to re- confirm and determine the mechanism and severity of the MR and the Valve Suitability for Repair, identify lesions of other valves( AV and TR severity, presence of PFO and Atherosclerotic plaque in ascending Ao )Post Cardiopulmonary Bypass (Post-CPB) MV repair assessment includes:Assessment of the : result of the repair which is the most important finding, Residual MR severity , Coaptation length of the MV leaflets , presence of the Mitral stenosis , presence of the Systolic anterior motion, Aortic regurgitation, Circumflex artery occlusion , intracardiac air, Global right or left ventricular function.