Conservative surgical management of mitral insufficiency: an alternative approach

Abstract

Mitral valve insufficiency is frequently the result of elongated or ruptured chordae tendineae. Several techniques have been described for its correction. However, when there is a severe elongation or rupture of the chordae, the most widely accepted treatment option has been valve replacement. The best long-term outcomes observed in conservative surgeries led us to choose this procedure rather than the correction of mitral valve insufficiency. We described three techniques for correction of mitral prolapse due to elongated and/or ruptured chordae tendineae. In addition, we developed mold pre built bovine pericardial chords (Braile-Gregori prosthesis) for chordae replacement. Finally, since 1987, the rigid prosthetic semicircular ring (Gregori-Braile ring) has been consistently used in our centre for correction of the posterior dilation of mitral annulus preferably in its portion close to the posteromedial commissure. Descriptors: Mitral valve/surgery. Mitral valve insufficiency. ResumoA insuficiência mitral é frequentemente resultado do alongamento ou ruptura das cordas tendíneas. Várias técnicas foram descritas para sua correção. Entretanto, quando o comprometimento das cordas é mais intenso, a substituição valvar tem sido mais usualmente empregada. Os bons resultados a longo prazo observados na cirurgia conservadora têm nos levado a eleger esse procedimento como prioridade. Três técnicas foram por nós desenvolvidas para correção de alongamento e/ou ruptura de cordas tendíneas. Além disso, desenvolvemos uma prótese de pericárdio bovino para a substituição de cordas (prótese Braile-Gregori). Finalmente, desde 1987 empregamos o anel rígido semicircular (anel GregoriBraile) para a correção do alongamento posterior do anel mitral, com ênfase na sua porção junto à comissura póstero-medial. Descritores: Valva mitral/cirurgia. Insuficiência da valva mitral.RBCCV

Mitral valve prolapse in pregnancy

“…The female patients with severe MR and significant symptoms, or left ventricular functional impairment, warrant a valvular operation before a planned pregnancy, favorably with a valve repair procedure. Due to the fact that MVP is often a result of elongated or ruptured chordae tendineae, correction of MVP can be resorted to chordae replacement with mold pre built bovine pericardial chords (Braile-Gregori prosthesis) in addition to the rigid prosthetic semicircular ring (Gregori-Braile ring) for correction of mitral annulus dilation, in the replace of the widely accepted valve replacement [ 31 ] . The management strategies of MR due to MVP in pregnant patients were summarized in Figure 2 .…”