Mitral valve training › Guides › Surgical repair (annuloplasty ring)

Surgical mitral repair (annuloplasty ring) on echo

What to look for: A bright ring, a still posterior leaflet, neochords; jets inside or outside the ring.

Key findings

• The ring (a complete ring or a partial band) is bright along the annulus; after a posterior repair the posterior leaflet is short and moves little.
• Neochords are thin, straight, bright lines from the papillary muscles to the leaflet.
• Residual MR comes through the leaflets; a jet outside the ring means ring dehiscence.

Grading after repair

• Residual MR through the leaflets is graded as native MR: vena contracta <3 mm mild, ≥7 mm severe, with the CW density and the pulmonary vein flow.
• A small ring can make the valve stenotic: measure the mean gradient and state the heart rate.

Pitfalls

• SAM can follow a repair, with the anterior leaflet pushed into the outflow tract: look at the outflow tract and its gradient.

In the simulator every case varies the anatomy, the jets and the measurements: watch the lesion in Learn, then grade new cases in Practice and compare your answer with the exact one.

Related

Edge-to-edge repair (TEER clip) · Bioprosthetic mitral valve · Mechanical mitral valve

Educational simulation to use under the supervision of a clinical tutor — not for clinical use.