Mitral valve repair surgery is much more technically demanding and may involve higher risk. Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever. In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease) or non-ischemic heart disease (dilated cardiomyopathy). In 1923 Dr. Elliott Cutler of the Peter Bent Brigham Hospital performed the world’s first successful heart valve surgery – a mitral valve "repair". The patient was
Mitral valve away from the free margin. This disposition has important effects on systolic stress distribution physiology The mitral annulus is a fibrous ring that is attached to the mitral valve leaflets. Unlike prosthetic valves, it is not continuous. The mitral annulus is saddle shaped and changes in shape throughout the cardiac cycle. The annulus contracts and reduces its surface area during systole to help provide complete closure of the leaflets. Expansion of the annulus can result in leaftlets that do not join soundly together, leading to functional mitral regurgitation. The normal diameter of the mitral annulus is , and the circumference