Intraoperative assessment of mitral valve competence: A safe and reliable technique

Background and aims of the study: In mitral valve (MV) reconstructive surgery, the most difficult problem is immediate, intraoperative assessment of the repaired valve. We describe a simple technique of assessing the MV after the repair while the left atrium (LA) is still open. Methods: The heart is perfused through a coronary line, after frustrating the MV with a multiholed disposable chest tube, and made to beat while the aorta is declamped. After de-airing, the frustrater is removes and the coronary line flow is gradually increased to one third of the arterial pump output. Within the blood filled pericardial well, through the opened LA, the MV is assessed for competence. The method allows for taking any corrective steps to achieve a competent MV before proceeding further. Results: Over the last 10 years, the method was used in 106 patients undergoing MV repair. It allowed us to take corrective steps in all 31 patients (29.2%) who were found to have significant mitral regurgitation. No complication which could be attributed to the method of testing was documented. Conclusions: The method is found to be simple, safe, reliable, and has ensured against accepting less than optimal results.