Degenerative Mitral Valve Research Articles

A complexity scoring system for degenerative mitral valve repair

ObjectiveTo develop a score to allow stratification of complexity in degenerative mitral valve repair. MethodsRetrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164). ResultsMitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar. ConclusionsOur scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.

Mitral Valve Repair versus Mitral Valve Replacement for Degenerative Mitral Valve Disease in Elderly Patients

Background: Due to demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Mitral Valve Repair (MV-repair) is the gold-standard treatment option for patients with degenerative MV disease. Nevertheless, in elderly patients, there is still controversy if MV-repair improves outcomes of patients compared with mitral valve replacement (MVR). We reviewed results after MV surgery for degenerative MV disease in elderly patients treated at our institution over the past 20 years.

Galectin-3 in cardiac muscle and circulation of dogs with degenerative mitral valve disease

ObjectivesThis study aimed to determine the association of cardiac fibrosis with the galectin-3 (Gal-3) expression, a fibrosis marker in the myocardium and to compare plasma Gal-3 levels in normal and degenerative mitral valve disease (DMVD) dogs. AnimalsStudies of muscle expression and plasma levels of Gal-3 were performed in separate groups of dogs. The tissue study was performed on cardiac tissues collected from 22 dogs. The plasma study was performed on 46 client-owned dogs. MethodsPapillary muscle and left ventricular (LV) wall obtained from 10 normal and 12 DMVD dogs were stained with Masson trichrome and Gal-3 immunohistochemistry to determine fibrosis areas and Gal-3 expression. Plasma samples were collected from 19 normal and 27 DMVD dogs for Gal-3 measurement by ELISA. ResultsPercentage of fibrosis was higher in papillary muscle and LV wall of DMVD dogs (66.13 ± 5.58%; 52.98 ± 8.45%) than in normal dogs (35.40 ± 8.46%; 27.41 ± 7.91%; p < 0.0001). Gal-3 was higher in papillary muscle and LV wall of DMVD dogs (27.95 ± 6.94%; 17.25 ± 8.76%) than in normal dogs (1.08 ± 0.67%; 0.52 ± 0.42%; p < 0.0001). Fibrosis areas correlated strongly with the Gal-3 expression (r = 0.821, p < 0.0001). Plasma Gal-3 levels were increased in DMVD dogs (1.50; 0.87–2.36 ng/mL) compared to normal dogs (0.42; 0.27–0.63 ng/mL; p < 0.0001). ConclusionsGal-3 expression in cardiac muscle was associated with cardiac fibrosis and was higher in DMVD dogs than in normal dogs. DMVD dogs had higher plasma Gal-3 concentrations than normal dogs. Tissue Gal-3 is a candidate of fibrosis biomarker in DMVD; however, further investigation of associations between plasma Gal-3 and myocardial fibrosis is necessary.

Comparison of the effects of long-term pimobendan and benazepril administration in normal cats.

Pimobendan (PIMO) can cause adverse effects, such as mitral valve degeneration, in dogs; however, it is unclear whether these effects occur in cats. Therefore, we aimed to determine whether PIMO or benazepril produces adverse cardiac effects in healthy cats. This was a blinded, randomized, prospective parallel study. Twelve cats were randomly divided into two groups of six cats, namely, an angiotensin-converting-enzyme inhibitor group that received benazepril and a PIMO group. Cats were administered their respective treatments for 506 days, and we evaluated cardiac parameters, blood biochemistry and glomerular filtration rates during that time. At the end of the trial, the cats were euthanized, and histopathological examinations were performed by a pathologist who was blinded to the treatment groups. No significant changes were observed in any of the parameters measured in either of the groups. In particular, no significant cardiac lesions were observed in either of the groups. In healthy cats, neither PIMO nor benazepril appears to cause cardiac lesions, but future studies are needed to examine the effects of PIMO in cats with heart disease.

Degenerative mitral valve disease

Дегенеративните заболявания на митралната клапа са главна причина за сърдечно-съдова болестност и смъртност. Дегенерацията на митралната клапа е честа увреда, засягаща около 2% от населението. Най-честа находка е клапен пролапс, водещ до различна по степен митрална регургитация (МР). Митралният клапен пролапс, причинен от дегенеративни промени на митралната клапа, може да е в резултат на различни промени: от проста руптура на хорда, водеща до пролапс на изолиран сегмент от нормална по структура клапа, до мултисегментен пролапс на едното или двете платна на клапата с повече тъкан и дилатиран пръстен. Прогнозата на митралния клапен пролапс е сравнително благоприятна и не се различава съществено от тази на останалата популация, но хората с допълнителни рискови фактори като възраст, левокамерна дисфункция, значима митрална регургитация, дилатация на ляво предсърдие/камера и предсърдно мъждене, са с повишен риск от значими сърдечно-съдови събития. Препоръчван метод на лечение е пластика на митралната клапа, тъй като тя води до по-добри резултати в сравнение с протезирането на митралната клапа. От съществено значение е детайлното предоперативно разпознаване на конкретната патология както от кардиолог, така и от кардиохирург, тъй като са налице различни оперативни техники за реконструкция на митралната клапа. Своевременната и съответна по вид интервенция на пациентите с дегенеративни заболявания на митралната клапа може да подобри прогнозата и качеството на живот на тези болни.

Prevalence and Prognosis of Anemia in Dogs with Degenerative Mitral Valve Disease.

In humans, heart failure (HF) and renal insufficiency (RI) have negative reciprocal effects, and anemia can exacerbate their progression. In this retrospective study, the prevalence and prognostic significance of anemia in 114 dogs with degenerative mitral valve disease (DMVD) was investigated. Pretreatment clinical parameters, prevalence of anemia and azotemia, and survival time were analyzed in relation to HF severity. The prevalence of anemia was highest in dogs with the modified New York Heart Association (NYHA) class IV HF (33.3%), followed by classes III (15.2%) and II (0%; p < 0.001). The presence of anemia was associated with HF severity and blood creatinine > 1.6 mg/dL (both p < 0.001). Anemic dogs had a shorter median survival [13 months; 95% confidence interval (CI): 0.7–19.1] than nonanemic dogs (28 months; 95% CI: 15.3–40.7; p < .001). NYHA class IV (hazard ratio (HR): 3.1, 95% CI: 2.2–4.3; p < 0.001), left atrium/aorta ratio > 1.7 (HR: 2.7, 95% CI: 1.7–4.2; p = 0.001), and presence of anemia (HR: 1.43, 95% CI: 1.1–1.9; p = 0.004) emerged as predictors of mortality. A cardiorenal-anemia syndrome-like triangle was observed and anemia was a prognostic factor for survival in dogs with DMVD.

The Burden of Pulmonary Hypertension in Patients with Degenerative Mitral Valve Disease in Enugu South-East Nigeria: An Echocardiographic Based Study.

Background:Pulmonary hypertension is a common complication of degenerative mitral valve disease, and contributes significantly to both morbidity and mortality. The use of medications for reduction of pulmonary pressure in patients is not a common practice by most physicians in this part of the world because of the absence of data on pulmonary hypertension.Aim:The authors set out to find the prevalence of pulmonary hypertension in patients with degenerative mitral valve disease and to determine if there are gender differences in affectation. This will form a basis for future research on the management of pulmonary hypertension in sub-Saharan Africa.Subjects and Methods:The echocardiographic records of 1390 patients carried out over a period of 4 years were retrospectively reviewed. The examinations were done with a Logic 500 MD echocardiographic machine. Tricuspid valve regurgitation velocity above 250 cm/s defined pulmonary hypertension. Data obtained included presence of degenerative mitral valve disease, pulmonary hypertension, age, and gender.Results:A total of 1390 echocardiogram reports done at Conquest Medical Imaging, Enugu, from July 2009 to August 2013 were retrospectively reviewed. Degenerative mitral valve disease was noted in 18.7% of the patients, (259/1390) made up of 149 males and 110 females with a mean age of 68.3 (14.4) years. Pulmonary hypertension was present in 30% of the patients (78/259) and affected males more than females.Conclusion:Pulmonary hypertension is common in patients with degenerative mitral valve disease in Enugu, and affects males more than females.

Ejection and filling rates assessed from cardiac magnetic resonance imaging: possible indices of Degenerative Mitral Valve Regurgitation

Ejection and filling rates assessed from cardiac magnetic resonance imaging: possible indices of Degenerative Mitral Valve Regurgitation

Rheumatic Mitral Valvulitis with a “Giant Vegetation”—A Case Report

Infective endocarditis (IE) is the infection of inner endothelial layer of the heart including the heart valves and it may present as rapidly progressive or manifest itself as subacute or chronic disease. The epidemiology of infective endocarditis has been changed over the past few decades and the incidence of IE in children in United States and Canada is 1 in 1250 pediatric hospital admissions in the early 1980s. At least 70% of infective endocarditis in children occurs with congenital heart disease whereas rheumatic heart disease in southern states of India and the degenerative mitral valve disease (myxomatous, mitral valve prolapse) in the western countries are the most underlying predisposing conditions to infective endocarditis in adolescents. The characteristic lesion of infective endocarditis is “vegetation” and a “large” vegetation >10 mm in size has been reported with an incidence of 15.9% - 62.5% in patients. The significance of vegetation size has been a subject of discussion for many years to predict the embolic episodes. Background of this case study illustrated the varying size and shape of giant vegetation attached to the anterior leaflet of mitral valve in an underlying rheumatic mitral valvulitis and its consequence of valve damage such as chordal rupture, flail leaflet and mitral regurgitation with a description of anatomic features and echocardiographic manifestations in a 10-year-old female child.

Extended myectomy in the treatment of patients with hypertrophic obstructive cardiomyopathy.

IntroductionPartial resection of the septal muscle is a well-established and effective method of surgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure is characterized by a low operative mortality rate and long-term clinical improvement that has been confirmed in numerous publications. Mitral insufficiency in patients with HOCM is mostly functional due to the effect of systolic anterior motion (SAM).AimTo present the early results of surgical treatment provided to HOCM patients and to compare the effectiveness of two surgical procedures: isolated myectomy and myectomy combined with mitral valve replacement.Material and methodsThe study analyzed a group of 49 patients (20 women) with HOCM who underwent surgical treatment between 2012 and 2015. Isolated myectomy was performed in 67.25% (n = 33) of patients, myectomy combined with mitral valve replacement in 30.61% (n = 15), and 1 (2.04%) patient underwent myectomy combined with mitral valvuloplasty (papillary muscle repositioning).ResultsA greater reduction of the left ventricular outflow tract (LVOT) gradient was observed in the population with concomitant mitral valve replacement in comparison to patients after isolated myectomy; the difference was statistically significant (p = 0.020). No significant correlation was observed between residual SAM and the grade of mitral regurgitation (p = 0.699) or between residual SAM and the LVOT gradient (p = 0.280).ConclusionsSurgical myectomy is a well-established, effective method of reducing increased LVOT gradients in patients with HOCM. Additional mitral valve replacement may be associated with greater reductions of the LVOT gradient in the early postoperative period. Valve replacement should be considered in patients with concomitant mitral valve degeneration and patients with narrowed left ventricular cavities.

Transapical Off-pump Neochord Implantation for Mitral Regurgitation Recurrence

Recently, transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI) using the NeoChord DS-1000 device (NeoChord, Eden Praire, United States, Figure 1) has been proposed to correct degenerative mitral regurgitation. The surgical procedure is illustrated step-by-step in Figure 2 and it is performed under 2and 3-dimensional transesophageal echocardiography guidance. We present the first TOP-MINI procedure in a symptomatic 58-year-old patient with reappearance of severe mitral regurgitation 4 years after conventional mitral valve repair with an annuloplasty band and implantation of 2 neochordae to treat a posterior mitral leaflet flail at P2 segment (Figures 3A and 3B, videos 1 and 2 of the supplementary material). The patient was enrolled in our institutional prospective registry approved by the local Ethics committee. The patient signed informed consent. A successful TOP-MINI procedure was performed with 5 Neochords implanted on the posterior mitral leaflet (Figures 3C-3F, videos 3 and 4 of the supplementary material). The patient was discharged home after 5 postoperative days. At 6 months, the patient was asymptomatic and transthoracic echocardiography showed the absence of any residual mitral regurgitation (Figures 3G-3H, videos 5 and 6 of the supplementary material). The TOP-MINI procedure is approved in Europe for patients with degenerative mitral valve disease independently of their risk profile. We proposed this therapeutic option because, in our experience, it is associated with extremely low complication rates and high success rates in patients with posterior mitral leaflet disease limited to P2 segment. In this specific case, the presence of a previously implanted annuloplasty band also provided an extra support for the repair by diminishing the stress on the repaired leaflet and possibly increasing durability.

Serum serotonin concentration in small breed dogs with degenerative mitral valve disease

This study investigated the potential associations of dog characteristics with serum serotonin (5HT) concentration in dogs with degenerative mitral valve disease (DMVD). Client-owned dogs were prospectively recruited at the Veterinary Medical Teaching Hospital of Chungnam National University between 2010 and 2011. Forty-two dogs (22 females and 20 males) were enrolled in this study. DMVD dogs included Maltese (n=12), followed by Shih-tzu (n=10), mixed breed (n=5), Chihuahua (n=4), Miniature schnauzer (n=3), Miniature poodle (n=3), Miniature pinscher (n=1), Pomeranian (n=1), Yorkshire terrier (n=2), and Spitz (n=1). As inclusion criteria for the study, dogs had to show either direct or echocardiographic evidence of DMVD. Platelet count significantly differed among the three groups, as the moderate (p&lt;0.05) and severe groups (p&lt;0.05) showed significantly higher platelet counts than the mild DMVD group. Additionally, significantly higher LVIDd, LVIDs, fractional shortening (FS), and LA:Ao ratios were observed in dogs with moderate (p&lt;0.05) and severe (p&lt;0.05) DMVD compared to the mild group, respectively. Significant positive correlations between serum 5-hydroxytryptamine (5HT) concentration and platelet count (r=0.273, P=0.03), LA:Ao ratio (r=0.459, P=0.001), and LVIDd (r=0.319, P=0.013) were observed in DMVD dogs. Therefore, serum 5HT concentration may be a potential cause of DMVD progression.

Off pump mitral valve repair

The NeoChord DS1000 is a disposable device used to replace damaged chordae by delivering artificial chordae tendinae in a beating heart through small anterolateral thoracotomy. It gives alternative approach in treating degenerative mitral valve insufficiency.

Three-dimensional dynamic morphology of the mitral valve in different forms of mitral valve prolapse - potential implications for annuloplasty ring selection.

BackgroundReal-time three-dimensional transesophageal echocardiography has increased our understanding of the distinct pathomechanisms underlying functional, ischaemic or degenerative mitral regurgitation. However, potential differences in dynamic morphology between the subtypes of degenerative mitral prolapse have scarcely been investigated.MethodsIn order to compare the dynamic behavior of the different phenotypes of degenerative mitral valve prolapse, real-time three-dimensional transesophageal echocardiography recordings of 77 subjects, 27 with Barlow disease (BD), 32 with Fibroelastic deficiency (FED) and 18 normal controls (NC) were analysed.ResultsGeometric annular and valvular parameters of the myxomatous patients were significantly larger compared to controls (BD vs. FED vs. NC 3D annular area: 15 ± 2.8 vs. 13.3 ± 2.4 vs. 10.6 ± 2.3cm2, all p < 0.01). Beside similar ellipticity, BD annuli were significantly flatter compared to FED. Myxomatous annuli appeared less dynamic than normals, with decreased overall 3D area change, however only the BD group differed from NC significantly (BD vs. FED vs. NC normalized 3D area change 4.40 vs. 6.81 vs. 9.69 %; BD vs. NC p = 0.000; FED vs. NC p = not significant, BD vs. FED p = 0.025).ConclusionBD and FED differ not only in terms of valve morphology, but also annular dynamics. Both pathologies are characterized by annular dilatation. However, in BD the annulus is remarkably flattened and hypodynamic, whereas in FED its saddle-shape and contractile function is relatively preserved. These features might influence the choice of repair technique and the selection of annuloplasty ring.

Непосредственные результаты хирургического лечения выраженной бессимптомной митральной недостаточности дегенеративного генеза

Непосредственные результаты хирургического лечения выраженной бессимптомной митральной недостаточности дегенеративного генеза

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract 11753: Disjunction of the Mitral Annulus Is Associated With Paradoxical Systolic Expansion and Flattening in Degenerative Mitral Valve Disease: A Real-time 3-dimensional Transesophageal Echocardiographic Study

Introduction: Disjunction of the mitral annulus, defined as a separation between the atrial wall-mitral valve junction and the left ventricular attachment, is commonly seen on echocardiography in patients with degenerative mitral valve prolapse (MVP). Few data exists on the three-dimensional (3D) geometry of annular disjunction and its relationship with the annular dynamic function. Hypothesis: We assessed the hypothesis that annular disjunction is associated with abnormal annulus structure and function. Methods: A total of 138 subjects including 108 MVP patients (58±11years) and 30 subjects with normal MV (57±15years) were studied using real-time 3D transesophageal echocardiography. The annular circumference was examined in multiple radial planes at 10° intervals for any disjunction. The location, separation distance, and circumferential extent of disjunction were assessed. The annular area, width, and height were measured at end-diastole and end-systole. Results: Annular disjunction was evident in 61 (56%) MVP patients and 3 (10%) normal subjects (P&lt;0.0001). Among MVP patients, disjunction is usually located adjacent to the prolapsed segments, circumferentially spanning over 79°±42° (20° to 190°) of the annulus, with the maximal separation measuring 8.7±3.8mm. Annular disjunction is associated with more prolapsed segment (2.0±1.6 vs 1.3±0.6, P=0.0021), more severe mitral regurgitation (effective regurgitant orifice area=0.64±0.49 vs 0.45±0.23cm 2 , P&lt;0.0001), paradoxical systolic increase in annular area and decrease in height-to-commissural width ratio (AHCWR) (Figure), despite normal ventricular ejection fraction (62±5% vs 62±7%, P=0.97). Conclusions: Mitral annular disjunction is associated with decoupling of annular and ventricular function leading to paradoxical annular expansion and flattening of the annular saddle-shape during systole in patients with MVP and may require specific surgical correction.

Abstract 17188: Calcific Degenerative Mitral Disease vs Myxomatous Degeneration: Crystallizing the Differences

Introduction: Myxomatous (M) and other non-M, non-ischemic valve pathologies are often all classified as “degenerative mitral valve disease.” We have seen at TEE and surgery a subgroup of older patients with normal or reduced leaflet area, leaflet cholesterol deposition, annular fibrosis and calcification and thickened chordae - at most only two are ruptured. We classify these pts as “calcific degenerative (D).” Hypothesis: Pts with D have different outcomes and require different techniques than pts with M. Methods: Since 1994, D and M have been recorded prospectively and separately; 205 patients had D pathology, 654 had M. Results: D pts were more often female: 63% (130/205) vs. M, 32% (209/654) p&lt;0.0001; older : 69.20±11.34 vs. 60.86±13.42 years, p&lt;0.0001; had a lower preop EF: 55.97±12.82 vs. 61.80±9.10, p&lt;0.0001; smaller preop annular AP diameter: 41.59±5.60 vs. 44.36±4.00, p&lt;0.0001; more concurrent AVRs: 8.8% (18/205) vs. M: 3.5% (23/654) p=0.0038; had fewer posterior chordal replacements: 4.06±1.54 vs. 4.67±1.53, p=0.0016 and smaller ring sizes D: 28.22±3.06 vs. M: 30.72±2.86, p&lt;0.0001. Periop mortality was higher in D: 3.9% (8/205) in D vs 1.2% (8/654) of M pts, p=0.0293. Late 10-yr survival (Kaplan-Meier) was D, 37.94%, and for M, 71.3%, p&lt;0.0001. Late 10-yr freedom from reoperation (Kaplan-Meier) was for D, 95.6% and for M, 93.2%, p=0.375. Late 10-yr freedom from significant mitral regurgitation (MR) (Kaplan-Meier) was for D, 79.9%, and for M, 85.9%, p=0.269. Cox regression for predictors of mortality identified age (relative risk (RR) 1.078, p&lt;0.0001), sex (RR 0.715, p=0.0320) preop EF (RR 0.985, p=0.0220), concomitant CAB (RR 1.614, p=0.0058), posterior leaflet repaired (RR 0.581, p=0.0058) or both posterior and anterior leaflet repaired (RR 0.500, p=0.0150), and leaflet calcification, (RR 1.734, p=0.0440); for predictors of reoperation, age (RR 0.971, p=0.048) and sex (RR 2.914, p=0.040); and for a predictor of late MR, annuloplasty ring size (RR 1.242, p=0.0094). Conclusions: These data confirmed that the D group had distinct clinical and pathological features which can be identified preoperatively and intraoperatively. Leaflet resection is not successful in these patients. Reconstructive techniques are preferred.

Abstract 19622: Trans-apical Off-pump Mitral Valve Repair With Neochords Implantation: One Year Clinical and Echocardiographic Follow-up

Introduction: TOP-MINI is a new micro invasive surgical procedure to treat degenerative mitral valve regurgitation due to flail/prolapse. Hypothesis: This prospective single centre study sought to assess the safety and effectiveness of the TOP-MINI procedure up to one year follow-up. Methods: Clinical and Echocardiographic outcomes were evaluated at 1, 3, 6 months and 1 year follow-up for all patients underwent TOP-MINI procedure from November 2013 to March 2015. Procedural success was defined as residual MR≤2+ at any time. Results: Sixty-one patients were treated during study period. One year survival was 96.7±2.3%. Freedom from MR&gt;2+ is shown in figure 1 Panel A, Freedom from MR&gt;2+ according to valve anatomy (Type A isolated P2 disease, Type B posterior multisegment disease, Type C anterior or bileaflet and/or calcified disease) is shown in Figure 1 Panel B. Freedom from MR&gt;2+ according to STS risk profile is shown in Figure 2. The trend of Echocardiographic parameters is shown in Figure 3. Conclusions: TOP-MINI is a safe and effective procedure at 1 year FU. Residual MR is influenced by valve anatomy showing good results in Type A and B patients. Future techniques refinements are needed in order to improve outcomes of Type C patients. The lack of annuloplasty procedure does not influence negatively left ventricle reverse remodeling.

ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse &gt; 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail