Abstract
Purpose
There are an increasing number of reports concerning mitral valve repair by a reconstruction of the chordae tendinae using expanded polytetrafluoro-ethylene (PTFE) sutures. However, little information is available about extended application or results of this technique for an extended prolapse of the anterior mitral leaflets.
Methods
Between July 1991 and August 2003, 28 patients with moderate to severe mitral regurgitation as a result of a prolapse of anterior leaflets (age range, 15–73 years) underwent mitral valve repair by reconstruction of the artificial chordae with 4-CV expanded polytetrafluoroethylene sutures without a leaflet resection. Either Kay’s suture technique or ring annuloplasty was also performed to correct annular dilatation in all patients.
Results
No operative death or late mortality was observed. The prolapsed segment, which was successfully repaired, was within 33% of the anterior mitral leaflet (AML) in 6 patients, from 33% to 50% in 5, from 50% to 99% in 11, and 100% in 6 patients. Before discharge, immediate postoperative echocardiography showed less than moderate mitral regurgitation in 28 of 28 patients. The follow-up, consisting of a clinical examination and serial echocardiograms, was complete in all cases and the mean follow-up period was 80.6 months (range, 12–146). There were two failures that required a reoperation because of a worsening mitral regurgitation and hemolytic anemia (elongation of anchored side of papillary muscle). The other two patients required mitral valve replacement due to a progressive regression of the left ventricular function, although the regurgitation worsened from a mild level to a moderate one. When the reoperated patients were excluded from the following data, the degree of mitral regurgitation, estimated by echocardiography performed at recent follow-up period, was none in 10 patients, trivial in 13 patients, and mild in 1 patient. In addition, the systolic and diastolic dimensions of the left ventricle decreased significantly (P < 0.01).
Conclusions
The replacement of artificial chordae was not complicated and it seemed to help to preserve a good relationship among leaflet tissues, chordae, and papillary muscles. We therefore suggest that the extensive use of PTFE artificial chordae appears to be a promising procedure for the repair of all kinds of mitral lesions causing mitral regurgitation.
Similar content being viewed by others
References
N Ranganathan MD Silver TI Robinson WJ Kostuk CH Felderhof NL Patt et al. (1973) ArticleTitleAngiographic-morphologic correlation in patients with severe mitral regurgiation due to prolapse of the posterior mitral leaflet Circulation 48 514–8 Occurrence Handle4726234
MJ Davis BP Moore MV Braimbridge (1978) ArticleTitleThe floppy mitral valve: study of incidence, pathology and complications in surgical, necropsy and forensic material Br Heart J 40 468–81 Occurrence Handle656211
A Carpentier (1983) ArticleTitleCardiac valve surgery — the “French correction.” J Thoracic Cardiovasc Surg 86 323–37
TE David (1989) ArticleTitleReplacement of chordae tendineae with expanded polytetrafluoroethylene sutures J Card Surg 4 286–90 Occurrence Handle2520006
C Zussa RWM Frater E Polesel M Galloni C Valfre (1990) ArticleTitleArtificial Mitral valve chordae: experimental and clinical experience Ann Thorac Surg 50 367–73 Occurrence Handle2400256
RWN Frater S Gabby D Shore S Factor J Storm (1983) ArticleTitleReproducible replacement of elongated or ruptured mitral valve chordae Ann Thorac Surg 35 14–27 Occurrence Handle6849579
RWM Frater HO Vetter C Zussa M Dahm (1990) ArticleTitleChordal replacement in mitral valve repair Circulation 82 IssueIDsuppl IV125–30 Occurrence Handle2225397
TE David J Boss H Rakowski (1991) ArticleTitleMitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures J Thorac Cardiovasc Surg 101 495–501 Occurrence Handle1999944
K Kawazoe K Eishi Y Sasako Y Kosakai Y Kitoh N Nakajima et al. (1992) ArticleTitleClinical experience of mitral valve reconstruction with artificial chordae implantation Eur J Cardiothorac Surg 6 297–301 Occurrence Handle10.1016/1010-7940(92)90145-N Occurrence Handle1616725
C Zussa E Polesel U Da Col M Galloni C Valfre (1994) ArticleTitleSeven-year experience with chordal replacement with expanded polytetrafluoroethylene in floppy mitral valve J Thorac Cardiovasc Surg 108 37–41 Occurrence Handle8028377
Y Tomita H Yasui R Tominaga S Morita M Masuda K Kurisu et al. (2002) ArticleTitleExtensive use of polutetrafluoroethylene artificial grafts for prolapse of bilateral mitral leaflets Eur J Cardiothorac Surg 21 27–31 Occurrence Handle10.1016/S1010-7940(01)00990-3 Occurrence Handle11788251
F Helmcke NC Nanda MC Hsiung B Soto CK Adrey RG Goyal et al. (1987) ArticleTitleColor Doppler assessment of mitral regurgitation with orthogonal planes Circulation 75 175–83 Occurrence Handle3791603
S Morita H Yasui Y Harasawa Y Tomita R Tominaga (1996) ArticleTitleExtensive use of artificial chordae for repairing diffuse mitral valve prolapse Ann Thorac Surg 62 878–80 Occurrence Handle8784025
Y Tomita H Yasui R Tominaga (1997) ArticleTitleMitral valve repair for isolated double-orifice mitral valve with torn chordae Ann Thorac Surg 64 1831–4 Occurrence Handle10.1016/S0003-4975(97)01070-9 Occurrence Handle9436589
K Kinoshita M Oe K Tokunaga (1991) ArticleTitleSuperior protective effect of low-calcium, magnesium-free potassium cardioplegic solution on ischemic myocardium. Clinical study in comparison with St. Thomas’ Hospital solution J Thorac Cardiovasc Surg 101 695–702 Occurrence Handle2008108
P Perier A Deloche S Chauvaud JN Fabiani P Rossant JP Bessou et al. (1984) ArticleTitleComparative evaluation of mitral valve repair and replacement with Starr, Bjork, and porcine valve prostheses Circulation 70 IssueIDsuppl I I187–92 Occurrence Handle6744563
AC Galloway SB Colvin FG Baumann EA Grossi GH Ribakove S Harty et al. (1989) ArticleTitleA comparison of mitral valve reconstuction with mitral valve replacement: Intermediate-term results Ann Thorac Surg 47 655–62 Occurrence Handle2730188
A Deloche VA Jebara JY Relland S Chauvaud JN Fabiani P Perier et al. (1990) ArticleTitleValve repair with Carpentier techniques. The second decade J Thorac Cardiovasc Surg 99 990–1001 Occurrence Handle2359339
CG Duran (1986) ArticleTitleRepair of anterior mitral leaflet chordal rupture or elongation (the flip-over technique) J Card Surg 1 161–6 Occurrence Handle2979918
Gregory F SuffixJr R Takeda S Silva L Faqanha MA Meier (1988) ArticleTitleA new technique for repair of mitral insufficiency caused by ruptured chordae of the anterior leaflet J Thorac Cardiovasc Surg 96 765–8 Occurrence Handle3184970
RP Cochran KS Kunzelman (1991) ArticleTitleComparison of viscoelastic properties of suture versus porcine mitral valve chordae tendinae J Card Surg 6 508–13 Occurrence Handle1815776
RWM Frater (1996) ArticleTitleEditorial comment: 10th Gore-Tex chorda anniversary J Heart Valve Dis 5 348–51 Occurrence Handle8963456
TE David S Armstrong Z Sun (1996) ArticleTitleReplacement of chordae tendineae with Gore-Tex sutures: a ten-year experience J Heart Valve Dis 5 352–5 Occurrence Handle8858497
Y Kobayashi S Nagata F Ohmori K Eishi K Miyatake (1996) ArticleTitleMitral valve dysfunction resulting from thickening and stiffening of artificial mitral valve chordae Circulation 94 IssueIDsuppl II II129–32 Occurrence Handle8901733
DM Cosgrove WJ Stewart (1989) ArticleTitleMitral valvuloplasty Curr Probl Cardiol 14 355–415
M Yacoub M Halim R Radley-Smith R McKay A Nijveld M Towers (1981) ArticleTitleSurgical treatment of mitral regurgitation caused by floppy valves: repair versus replacement Circulation 64 IssueIDsuppl II 211–6
LH Cohn VJ DiSesa GS Couper PS Peigh W Kowalker Collins JJ SuffixJr et al. (1989) ArticleTitleMitral valve repair for myxomatous degeneration and prolapse of the mitral valve J Thorac Cardiovasc Surg 98 987–93 Occurrence Handle2811429
A Deloche VA Jebara JYM Relland S Chauvaud JN Fabiani P Perier et al. (1990) ArticleTitleValve repair with Carpentier techniques. The second decade J Thorac Cardiovasc Surg 99 990–1002 Occurrence Handle2359339
TE David S Armstrong Z Sun L Daniel (1993) ArticleTitleLate results of mitral valve repair for mitral regurgitation due to degenerative disease Ann Thorac Surg 56 7–14 Occurrence Handle8328879
TE David A Omran S Armstrong Z Sun J Ivanov (1998) ArticleTitleLong-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures J Thorac Cardiovasc Surg 115 1279–86 Occurrence Handle9628669
TE David DE Uden HD Strauss (1983) ArticleTitleThe importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation Circulation 68 IssueIDsuppl II II-76–82
AM Gillinov EH Blackstone Cosgrove III DM P Kerr A Marullo PM McCarthy et al. (2003) ArticleTitleMitral valve repair with aortic valve replacement is superior to double valve replacement J Thorc Cardiovasc Surg 125 1372–87 Occurrence Handle10.1016/S0022-5223(02)73225-X
M Yacoub M Halim R Radley-Smith R McKay A Nijveld M Towers (1981) ArticleTitleSurgical treatment of mitral regurgitation caused by floppy valves: repair versus replacement Circulation 64 IssueID2 Pt 2 II210–6 Occurrence Handle7249325
LH Cohn GS Couper SF Aranki RJ Rizzo NM Kinchla JJ Collins (1994) ArticleTitleLong-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve J Thorac Cardiovasc Surg 107 143–51 Occurrence Handle8283877
AM Gillinov DM Cosgrove EH Blackstone JH Arnord BW Lytle NG Smedira et al. (1998) ArticleTitleDurability of mitral valve repair for degenerative disease J Thorac Cardiovasc Surg 116 734–43 Occurrence Handle9806380
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tomita, Y., Yasui, H., Iwai, T. et al. Surgical Application for a Prolapse of the Anterior Mitral Leaflet by Replacing Artificial Chordae with Polytetrafluoroethylene Grafts. Surg Today 35, 812–818 (2005). https://doi.org/10.1007/s00595-005-3043-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-005-3043-2