Artificial Chordae in the Treatment of Mitral Valve Pathology

Summary

Following the results of animal experiments in the treatment of mitral valve pathology by insertion of artificial chordae, a clinical trial was started in November 1986. So far 5–0 polytetrafluoroethylene stitches have been inserted in chordal position in seven cases. The indications included multiple ruptures of the anterior leaflet chordae, resection of thickened or calcified chordae, and the reinforcement of leaflets which were no longer supported due to elongation and degeneration of natural chordae. In all cases other procedures, such as commissurotomy and/or suture annuloplasty, were also carried out. In one case intraoperative epicardial echocardiography showed persistent mitral regurgitation (MR) which led to prompt valve replacement. No operative or late mortality occurred during a follow-up period of up to 14 months, and no thromboembolic episodes were reported. Late echocardiographic assessment showed no MR in any of the cases, and the mean valve orifice area was 2.4 cm². The smallness of this series and the shortness of the follow-up period do not yet allow us to recommend widespread use of this procedure, but the encouraging short-term results do suggest extending the experience, particularly in young patients with degenerative valve pathology.

During the laboratory research phase of the work reported here Dr. Zussa was W. R. Hearst Fellow in Cardiac Surgical Research at the A. Einstein College of Medicine, Bronx, New York.