Augmenting mitral valve repair evaluation with intraoperative left ventricle pressure measurements

Surgical mitral valve repair remains the gold standard treatment of mitral regurgitation due to degenerative disease. Surgery is performed on the quiescent heart; therefore, assessments of valve repair success can only be made following separation from cardiopulmonary bypass. Intra-ventricular pressure measurements are often made in percutaneous valve procedures but has yet been described at the time of surgical repair. As an example, the saline test, whereby normal saline is injected across the mitral valve from the left atrium into the left ventricle, on the arrested heart remains an integral component of surgical repair. However, the haemodynamics of the saline test have never been evaluated. We present a simple and novel technique to quantify the saline test by passing a 22-G catheter across the mitral leaflets during saline testing under maximal ventricle distension. The saline test may be less informative among patients in whom the maximum generated left ventricle diastolic pressure is low. These data may be of help to a surgeon interpreting intraoperative saline tests with the hope of a competent mitral valve. As well, it may provide support for intraventricular pressure monitoring at the time of mitral valve surgery.