Mitral Valve Repair in Rheumatic Mitral Disease

  • Taweesak ChotivatanapongEmail author


Current understanding of the structure and dynamics of mitral valve complex allows surgeons to achieve improved results of mitral valve repair. With rheumatic mitral disease, attention should focus on restoration of normality of both diastolic and systolic functions of the mitral valve. Surgical techniques based on this approach have greatly increased the scope of repairing mitral valve in rheumatic mitral disease as well as the success rate. By virtue of repairing all of mitral valve components with the goals of restoration of type I movement, good coaptation and annular remodeling, rheumatic mitral valves can now be repaired safely and reproducibly. Despite encouraging results of repair of rheumatic mitral valves, with mixed or predominant stenotic lesions, close follow-up is mandatory. This chapter focuses on current state of the art as well as innovative techniques in repairing rheumatic mitral disease.


Chordal repair Chordal splitting Leaflet peeling Mitral stenosis Rheumatic mitral disease 


  1. 1.
    Carpentier A. Cardiac valve surgery: the “French Correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.CrossRefGoogle Scholar
  2. 2.
    Chauvaud S, Fuzellier JF, Berrebi A, et al. Long term (29 years) results of reconstructive surgery in rheumatic mitral insufficiency. Circulation. 2001;104:112–5.CrossRefGoogle Scholar
  3. 3.
    Kamblock J, Payot L, Iung B, et al. Does rheumatic myocarditis really exist? Systematic study with echocardiography and cardiac troponin blood level. Eur Heart J. 2003;24:855–62.CrossRefGoogle Scholar
  4. 4.
    Narula J, Chopra P, Talwar KK, et al. Does endomyocardial biopsy aid in diagnosis of active rheumatic myocarditis. Circulation. 1993;88:2193–205.CrossRefGoogle Scholar
  5. 5.
    Vasan RS, Shivastava S, Vijayakumar M, et al. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation. 1996;94:73–82.CrossRefGoogle Scholar
  6. 6.
    Folger GM Jr, Hajar R, Robida A, et al. Occurrence of valvular heart disease in acute rheumatic fever without evidence carditis: color-flow Doppler identification. Br Heart J. 1992;67:434–8.CrossRefGoogle Scholar
  7. 7.
    Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, et al. Global, regional and national burden of rheumatic heart disease,1990-2005. N Engl J Med. 2017;377:73–22.CrossRefGoogle Scholar
  8. 8.
    Zuhlke LJ, Karthikeyan G. Primary prevention for rheumatic fever. Glob Heart. 2013;8:221–6.CrossRefGoogle Scholar
  9. 9.
    Kumar AS, Talwar S, Saxena A, et al. Results of mitral valve repairin rheumatic mitral regurgitation. Interact Cardiovasc Thorac Surg. 2006;5:356–61.CrossRefGoogle Scholar
  10. 10.
    Chotivatanapong T. Surgical treatment of rheumatic mitral regurgitation. In: Schaefers H-J, editor. Current treatment of mitral regurgitation, 1st edition. Bremen: UNI-MED; 2010. p. 79–90.Google Scholar
  11. 11.
    Rumel WR, Vaughn CC, Guibone RA. Surgical reconstruction of the mitral valve. Ann Thorac Surg. 1969;8:289–96.CrossRefGoogle Scholar
  12. 12.
    David TE. Artificial chordae. Semin Thorac Cardiovasc Surg. 2004;16:161–8.CrossRefGoogle Scholar
  13. 13.
    Salvador L, Mirone S, Buanchini R, et al. A 20 years experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg. 2008;135:1280–7.CrossRefGoogle Scholar
  14. 14.
    Kasekawa H, Shimokawa T, Shibazaki I, et al. Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene suture. Ann Thorac Surg. 2006;81:1625–31.CrossRefGoogle Scholar
  15. 15.
    Chotivatanapong T, Chaiseri P, Kasemsarm C, et al. Chordal replacement with polytetrafluoroethylene suture: midterm results. Asian Cardiovasc Thorac Ann. 2001;9:90–2.CrossRefGoogle Scholar
  16. 16.
    Gilbert T, David TE, Singh S, et al. Tricuspid valve repair with an annuloplasty ring results in improved long term outcomes. Circulation. 2006;114(Supplement I):I 577–81.Google Scholar
  17. 17.
    Bernal J, Ponton A, Diaz B, et al. Surgery for rheumatic tricuspid valve disease: a 30 years experience. J Thorac Cardiovasc Surg. 2008;136:476–1.CrossRefGoogle Scholar
  18. 18.
    Roger J, Bolling S. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718–25.CrossRefGoogle Scholar
  19. 19.
    Carr JA, Savage EB. Aortic valve repair for aortic insufficiency in adults: a contemporary review and comparison with replacement techniques. Eur J Cardiothorac Surg. 2004;25:6–15.CrossRefGoogle Scholar
  20. 20.
    Rankin JS, Gaca JG. Techniques of aortic valve repair. Innovations (Phila). 2011;6:348–54.CrossRefGoogle Scholar
  21. 21.
    Gillinov M, Blackstone E, Cosgrove D III, et al. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg. 2003;125:1372–87.CrossRefGoogle Scholar
  22. 22.
    Ho HQ, Nguyen VP, Phan KP, et al. Mitral valve repair in rheumatic heart disease. Asian Cardiovasc Thorac Ann. 2004;12:341–5.CrossRefGoogle Scholar
  23. 23.
    Cox JL, Schuessler RB, Hj A, et al. The surgical treatment of atrial fibrillation III. Development of definitive surgical procedure. J Thorac Cardiovasc Surg. 1991;101:569–83.CrossRefGoogle Scholar
  24. 24.
    Gillinov M, Blackstone E, McCarthy P. Atrial fibrillation: current surgical options and their assessment. Ann Thorac Surg. 2002;74:2210–7.CrossRefGoogle Scholar
  25. 25.
    Lall S, Melby S, Voeller R, et al. The effect of ablation technology on surgical outcomes after the Cox-maze procedure: a propensity analysis. J Thorac Cardiovasc Surg. 2007;133:389–96.CrossRefGoogle Scholar
  26. 26.
    Romano MA, Bach DS, Pagani FD, et al. Atrial reduction plasty Cox maze procedure: extended indication for atrial fibrillation surgery. Ann Thorac Surg. 2004;77:282–7.CrossRefGoogle Scholar
  27. 27.
    Marui A, Tambara K, Tadamura E, et al. A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium. Eur J Cardiothorac Surg. 2007;32:308–12.CrossRefGoogle Scholar
  28. 28.
    Scherer M, Therapedis P, Wittlinger T, et al. Impact of left atrial size reduction and endocardial radiofrequency ablation on continuous atrial fibrillation in patient undergoing concomitant cardiac surgery. Three years results. J Heart Valve Dis. 2007;16:126–31.PubMedGoogle Scholar
  29. 29.
    Kosakai Y. Treatment of atrial fibrillation using the maze procedure. The Japanese experience. Semin Thorac Cardiovadc Surg. 2000;12:44–52.CrossRefGoogle Scholar
  30. 30.
    Guiraudon GM, Ofiesh JG, Kaushik R. Extended vertical transeptal approach to the mitral valve. Ann Thorac Surg. 1991;52:1058–62.CrossRefGoogle Scholar
  31. 31.
    Chiappini B, Sanchez A, Noirhomme P, Verhelst R, Rubay J, Poncelet A, Funken JC, El Khoury G. Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results. J Heart Valve Dis. 2006;15:657–63.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryCentral Chest Institute of ThailandNonthaburiThailand

Personalised recommendations