Mitral Valve Repair : Whenever possible, the valve has to be repaired rather than replaced. Preoperative investigations and a TEE done on the operating table will help the surgeon in decision-making. Final decision is made on the table after studying and testing the valve.
Alain Carpentier has perfected the technique of repair. According to him, the sectors (scallops) of the mitral leaflets are Al, A2 and A3 and on the posterior leaflet PI, P2, P3 (lateral, central and medial sectors). From a reference point, which is usually PI, one can assess the regurgitation in each segment and how much prolapse or redundancy of each scallop is there and also decide whether the chordae are ruptured or just lengthened.
He has also classified the valve pathology as (1) type One - with normal leaflet motion where regurgitation is due to annular dilatation and failure of coaptation of the leaflets in the middle, (2) Type two - where excessive mobility and prolapse of the valve is there, and (3) Type three - with restricted valve mobility as in combined stenotic and regurgitant valve of rheumatic heart disease or calcified valve due to other causes.