Importance of preserving the mitral subvalvular apparatus in mitral valve replacement

Acute early failure of a bioprosthesis after mitral valve replacement with completely preserved annuloventricular continuity

“…Preservation of both the anterior and posterior mitral subvalvular apparatus at the time of MVR was demonstrated to play an important role in preserving left ventricular regional wall motion and global left ventricular function. 5 It is unclear whether the tissue valve thrombosis has relevance to complete preservation of the mitral subvalvular apparatus. However, it might be possible that turbulence between the preserved posterior mitral leafl ets and the implanted biological prosthesis induces formation of thrombi under a condition of low cardiac output, subsequently resulting in restricted cusp motion.…”

Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR

“…Such a fixation point in close proximity to the left lateral ventricular wall would explain the lower peak clockwise velocity of Segment 5 (limited velocity of motion away from the insertion point) and lower counterclockwise velocity of Segment 6 (also limited velocity of motion away from the insertion point). Potential causes to be considered include the supporting structures connecting the basal part of the left ventricle to the annulus, the so-called "basal cords", which are known to be important structures and are left intact, for instance, during mitral valve replacements for this reason [18][19][20][21][22]. The tertiary cords, in particular, arise directly from the LV wall or from the trabeculae carnae and insert exclusively into the posterior mitral leaflet [18].…”

Importance of preservation of chordal apparatus in mitral valve replacement

“…Thomson described entrapment of a St Jude valve by the preserved chordal apparatus [60]. Some surgeons prefer bileaflet mechanical valves with low profile to avoid interference in disc motion by preserved chordae [52]. Esper experienced a case of subvalvular obstruction caused by the retained chordal apparatus, and recommended that if the AML is to be preserved, it should be mobilized posteriorly and nonsupported portions removed [61].…”

“…Natsuaki demonstrated that preservation of both AML and PML versus PML only resulted in better postoperative wall motion at apical and diaphragmatic regions, and was comparable with a group of patients who had undergone mitral valve repair [52]. Contrast left ventriculography was used for assessment.…”