CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 4

Mitral Valve Repair with Replacement of Chordae in the Anterior Mitral Leaflet: a Possibility to Extend the Indication in Mitral Valve Repair

O. Wendler, U. J. Straub, N. Nikoloudakis, S. Demertzis, Th. Graeter, H. J. Schäfers

Abstract:
Objective: To extend the opportunity for mitral valve repair (MVR) in mitral regurgitation (MR), we replaced elongated or ruptured chordae in the anterior (AML) and posterior (PML) leaflet with Gore-Tex sutures (GTS). Here we present our experience with chordal replacement in MR due to pathology of the AML. Material/Methods: Between October 1995 and June 1997 twenty-six pts with MR due to pathology of the AML underwent MVR with chordal replacement. All were presented with MR III-IV on transthoracic echocardiography (TTE) and NYHA III-IV. All patients showed dilated mitral rings with prolapse of the AML due to elongated chordae in 22 and rupture in 4. In addition chordae of the PML were elongated in 4 and ruptured in 10 pts. Two pts had endocarditis. Three pts had reoperation post coronary bypass grafting (CABG) and 8 received concomitant CABG. Elongated or ruptured chordae were replaced with GTS. Prolene sutures (Wooler) were used for ring reduction, in one pt a Carpentier ring was inserted. Intraoperatively transesophageal echocardiography (TEE) was performed. The pts were followed by TTE after 3, 6, 9 and 12 months. Results: Mean bypass time was 74,3min (± 24,7min) with an ischemic time of 53,6min (± 19min). The pts received 2,2 (1-5) GT-sutures/pt for reconstruction of the AML and PML. Intraoperatively the TEE had shown MR £ I in all pts. Actually all pts are alive and 24 (92,3%) present MR £ I in the TTE. One pt had a MR II 3 months and one showed MR III 6 months postoperatively with NYHA II. Conclusion: Using this safe technique of chordal replacement in MR due to predominant pathology of the AML, valves can be reconstructed, that otherwise would have been considered for valve replacement.

Keywords:
Mitral valve, mitral regurgitation, mitral valve repair, chordae tendinae, chordal replacement

Address for Correspondence:

Reference:
(CVE. 1997; 2 (4): 264-266)

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