Abstract
Objective
Leaflet folding plasty was introduced as an effective technique to avoid systolic anterior motion (SAM) after mitral valve repair. The purpose of this study was to investigate the midterm outcome of leaflet folding plasty following a review of our 10-year experience.
Methods
Between October 1997 and May 2008, a total of 45 patients with mitral valve regurgitation due to posterior leaflet prolapse were operated on using leaflet folding plasty (63% of posterior leaflet repair and 28% of overall mitral valve repair during the same period). The group comprised 29 men and 16 women, with a mean age of 63.2 years. There were 44 patients with degenerative valve disease and 1 with healed infective endocarditis. The prolapsed scallop were P1 in 1, P2 in 33, and P3 in 11 patients. Anterior mitral leaflet involvement was seen in two patients.
Results
Mitral valve repair was performed in all patients. SAM with residual mitral regurgitation was observed in two patients, with one requiring intraoperative revision. The 30-day mortality was 2.2% (one patient died from intestinal complications). The mean follow-up period for survivors was 38.1 months (range 1–127 months). The 1- and 5-year actuarial survival rates were 97.8% and 93.7%, respectively. None of the patients required reoperation during follow-up.
Conclusion
Midterm outcome of leaflet folding plasty for mitral valve repair was satisfactory. This technique accomplishes mitral valve repair safely in patients with mitral regurgitation due to posterior prolapse, with acceptable intermediate-term freedom from reintervention.
Similar content being viewed by others
References
Grossi EA, Galloway AC, Kallenbach K, Miller JS, Esposito R, Schwartz DS, et al. Early results of posterior leaflet folding plasty for mitral valve reconstruction. Ann Thorac Surg 1998;65:1057–1059.
Nakajima M, Tsuchiya K, Kobayashi K, Amano H, Takizawa K. Leaflet folding plasty for mitral valve repair: technical application and early outcome Gen Thorac Cardiovasc Surg 2005;53:69–73.
Grossi EA, Galloway AC, Parish MA, Asai T, Gindea AJ, Harty S, et al. Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique. J Thorac Cardiovasc Surg 1992;103:466–470.
Freeman WK, Schaff HV, Khandheria BK, Oh JK, Orszulak TA, Abel MD, et al. Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: incidence and significance of systolic anterior motion. J Am Coll Cardiol 1992;20:599–609.
Brown ML, Abel MD, Click RL, Morford RG, Dearani JA, Sundt TM, et al. Systolic anterior motion after mitral valve repair: is surgical intervention necessary? J Thorac Cardiovasc Surg 2007;133:136–133.
Maaslow AD, Regan MM, Haering JM, Johnson RG, Levine RA. Echocardiographic predictors of left ventricular outflow obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease. J Am Coll Cardiol 1999;34:2096–2104.
Lee KS, Stewart WJ, Lever HM, Underwood PL, Cosgrove DM. Mechanism of outflow tract obstruction causing failed mitral valve repair: anterior displacement of leaflet coaptation. Circulation 1993;88(part 2):24–29.
Mihaileanu S, Marino JP, Chauvaud S, Brizard C, Crare P, Latremouille C, et al. Left ventricular outflow obstruction after mitral valve repair (Carpentier’s technique): proposed mechanism of disease. Circulation 1998;(suppl I):78–84.
Tunick PA, Cziner DG, Katz ES, Perez MA JL, Kronzon I. Association between residual mitral regurgitation and left ventricular outflow obstruction after Carpentier ring mitral annuloplasty. Am J Cardiol 1992;70:689–691.
Meyns B, Vandommele J, Vlasselaers D, Peerenboom P, Daenen W, Flameng W. Severe left ventricular outflow tract obstruction despite sliding leaflet technique for repair of the mitral valve. J Thorac Cardiovasc Surg 1996;112:187–188.
Civelek A, Szalay Z, Roth M, Arnold R, Klovekorn WP, Vogt PR, et al. Post-mitral valve repair systolic anterior motion produced by non-obstructive septal bulge. Eur J Cardiothorac Surg 2003;24:857–861.
Levine RA, Vlahakes GJ, Lefebvre X, Guerrero JL, Cape EG, Yoganathan AP, et al. Papillary muscle displacement causes systolic anterior motion of the mitral valve: experimental validation and insights into the mechanism of subaortic obstruction. Circulation 1995;91:1189–1195.
Prah GN, Sheikh F. An unusual cause of systolic anterior motion of the mitral valve. J Cardiothorac Vasc Anesth 2001;15:81–83.
Jebara VA, Mihaileanu S, Acar C, Brizard C, Grare P, Latremouille C, et al. Left ventricular outflow tract obstruction after mitral valve repair: results of the sliding leaflet technique. Circulation 1993;88(part 2):30–34.
Perier P, Clausnizer B, Mistarz K. Carpentier “sliding leaflet” technique for repair of the mitral valve: early results. Ann Thorac Surg 1994;57:383–386.
Gillnov AM, Cosgrove DM. Modified sliding leaflet technique for repair of the mitral valve. Ann Thorac Surg 1999;68:2356–2357.
Spencer FC, Galloway AC, Grossi EA, Rivakove GH, Delianides J, Baumann FG, et al. Recent developments and evolving techniques of mitral valve reconstruction. Ann Thorac Surg 1998;65:307–313.
Nakajima M, Tsuchiya K, Inoue H, Kobayashi K, Mizutani E, Takizawa K. Leaflet folding plasty combined with annular plication for mitral valve repair. Ann Thorac Surg 2004;77:1103–1104.
Raman JS, Gupta R, Shah P, Setty R, Tambara K. Doublebreasted repair of the posterior mitral valve leaflet. Ann Thorac Surg 2002;74:2206–2207.
Calafiore AM, Di Mauro M, Actis-Dato G, Lorena Iaco A, Centofanti P, Forsennati P, et al. Longitudinal plication of the posterior leaflet in myxomatous disease of the mitral valve. Ann Thorac Surg 2006;81:1909–1910.
Mihaljevic T, Blackstone EH, Lytle BW. Folding valvuloplasty without leaflet resection: simplified method for mitral valve repair. Ann Thorac Surg 2006;82:e46–e48.
Quigley RL, Garcia FC, Badawi RA. Prevention of systolic anterior motion after mitral valve repair with an anterior leaflet valvuloplasty. J Heart Valve Dis 2004;13:927–930.
Sternik L, Zehr KJ. Systolic anterior motion of the mitral valve after mitral valve repair: a method of prevention. Tex Heart Inst J 2005;32:47–49.
Mascagni R, Al Attar N, Lamarra M, Calvi S, Tripodi A, Mebazza A, et al. Edge-to-edge technique to treat post-mitral valve repair systolic anterior motion and left ventricular outflow tract obstruction. Ann Thorac Surg 2005;79:471–474.
McCarthy PM, McGee EC, Rigolin VH, Zhao O, Subacius H, Huskin AL, et al. Initial clinical experience with Myxo-ETlogix mitral valve repair ring. J Thorac Cardiovasc Surg 2008;136:73–81.
Rescigno G, Matteucci MLS, Lacovoni A, Banfi C, Seddio F, Lorini L, et al. Systolic anterior motion after mitral valve repair: myectomy as an alternative solution. J Thorac Cardiovasc Surg 2003;126:1196–1197.
Crescenzi G, Landoni G, Zangrillo A, Guarracino F, Rosica C, La Canna G, et al. Management and decision making strategy for systolic anterior motion after mitral valve repair. J Thorac Cardiovasc Surg 2009;137:320–325.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nakajima, M., Tsuchiya, K., Honda, Y. et al. Midterm outcome of leaflet folding plasty for mitral regurgitation due to posterior leaflet prolapse. Gen Thorac Cardiovasc Surg 58, 271–275 (2010). https://doi.org/10.1007/s11748-009-0559-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-009-0559-1