Notes to avoid failure in mitral valvuloplasty.

Mitral valvuloplasty can be applied in many situations and is quite effective in many cases. However, since it requires surgical skill based on knowledge and experience, there is a risk for recurrent surgery and reoperation was necessary in 5-8% of all cases in the first three years. 80-95% required no reoperation in ten years. Reoperation was performed mostly in cases of active endocarditis and extensive anterior leaflet prolapse. Reasons for reoperation were incomplete repair, tissue injury on sutured portion, recurrent annulus dilatation, reprolongation of chordae and hemolysis. To attain better surgical results in of mitral valvuloplasty the basic technique should consist of the resection and suture method and the fragile portion should be sutured with a patch. Careful attention should be paid to attaining a good coaptation of leaflet at the end of repair, sufficient remodeling of dilated annulus and to careful suturing of the prosthetic ring. It is also important to have an experienced operator perform transesophageal echocardiogram, and if more than 2 cm2 residual regurgitation is observed, immediate examination and treatment should be performed. In case of mitral regurgitation after surgery, careful assessment for reoperation can contribute to good late surgical results.