Partial anterior mitral leaflet resection with adjacent ring plication – feasibility pilot study

Abstract

Valve replacement seems to be the most straightforward option for patients with mitral valve (MV) pathology. However, this approach is connected with all the intrinsic side effects of mechanical or biological valve implantation, including susceptibility to infection, thrombosis and degeneration. Thus, a reconstructive surgery has been recognized as the best option for the majority of patients including children. Many repair techniques have been developed to address mitral valve insufficiency (MI) in case of congenital, ischemic and infective pathologies. The majority of procedures concern the posterior mitral leaflet (PML) and the posterior annulus as well as commissures.The techniques regarding anterior mitral leaflet (AML) and anterior annulus are less frequently utilized in clinical practice as there is a concern of possible distortion of the aortic valve, narrowing of left ventricle outflow tract and unpredictable long-term MV function. Nevertheless, certain interventions on AML were introduced with acceptable results to treat MV systolic anterior motion, degenerative MV disease or Barlow disease (3, 7).Infective and congenital pathologies in children necessitate a search for an alternative reconstructive approach when all procedures utilizing implants (e.g. artificial chordae, pericardial patches) or an opera- Antosik P., Sologashwilli T., Pawelec-Wojtalik M., Wodziński A., Ładziński P., Bartkowska-Śniatkowska A., Bukowska D., Sobieraj M., Nałęcz T., Cudak E., Wojtalik M.Partial anterior mitral leaflet resection with adjacent ring plication -feasibility pilot study Summary The aim of the study was to assess the feasibility and repeatability of a partial removal of the anterior mitral leaflet medial part (AML-A3) accompanied by corresponding anterior mitral annulus plication as a method of valve repair. Four male land race pigs underwent median sternotomy and consecutive cardio-pulmonary by-pass under general anesthesia with hemodynamic monitoring. The AML was detached from the annulus at ⅓ of its length beginning from the postero-median commissure in the direction to the aortic valve and cut off towards the A2-A3 indentation. Three single 3-0 silk sutures were utilized to plicate the mitral annulus segment corresponding with the detached leaflet. The remaining free edge of the AML lateral part was reattached to the plicated ring and to the postero-median commissure with the running 5-0 polypropylene suture. Preoperative and postoperative epicardial echocardiography was performed. All animals survived the operation and were weaned from the cardiopulmonary bypass. All reconstructed MVs were competent. Mean MV diameter decreased after the plasty and did not cause significant diastolic MV flow velocity increase. LVOT anatomy was not altered as well as LVOT flow velocities remained unchanged. The AoV was competent after the operation and did not change its diameter. Partial AML resection completed by corresponding annulus plication is a feasible and repeatable procedure. It does not negatively influence the func...