Mitral valve repair best course of action. For patients with the most common type of mitral valve disease, termed "degenerative" or "myxomatous" mitral valve disease, repair rates are very high and long term durability is excellent. There has been great debate about timing of surgery in patients with asymptomatic mitral valve regurgitation. The traditional surgical approach to a mitral valve repair is a full or partial sternotomy, in which the surgeon cuts through the breastbone at the center of the chest to access the heart. There are minimally invasive (port access) options available pioneered by Hugo Vanerman in Belgium. The minimally invasive approach
Mitral insufficiency of the regurgitant flow at the level of the valve. This is known as the regurgitant orifice area, and correlates with the size of the defect in the mitral valve. One particular echocardiographic technique used to measure the orifice area is measurement of the proximal isovelocity surface area (PISA). The flaw of using PISA to determine the mitral valve regurgitant orifice area is that it measures the flow at one moment in time in the cardiac cycle, which may not reflect the average performance of the regurgitant jet. The treatment of mitral insufficiency depends on the acuteness of the disease