How to prevent SAM in mitral valve reconstruction

Methods We present a retrospective study on 120 cases with degenerative mitral regurgitation in which surgical mitral reconstruction has been tried in the last 5 years. 29 Barlow diseases, 50 FED, 20 idiopathic calcification of PML. Preoperative echographic and intraoperative valve analysis reveals risks factors for SAM; small LV, bulging septum, redundant leaflets, reduced mitro aortic angle, anterior coaptation line. All patients were operated with classical approach, median sternotomy, CEC, standard techniques for mitral valve reconstruction. Surgical methods for SAM prevention are; rings of corresponding dimensions, avoidance of large quadrangular resections, reconstruction of correct ratio between PML and AML dimensions by annular sliding; for large PML prefers the chordae insertion or butterfly resection.