Triangular Resection and Folding of Posterior Leaflet for Mitral Valve Repair

Col, Uberto Da; Bella, Isidoro Di; Bardelli, Giuliana; Koukoulis, Giovanna; Ramoni, Enrico; Ragni, Temistocle

doi:10.1111/j.1540-8191.2006.00231.x

Cited by 18 publications

(12 citation statements)

References 4 publications

(3 reference statements)

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“…7,12 Our findings in nondistended leaflets also suggest improved valve function, in terms of leaflet coaptation and mobility, compared with quadrangular resection. Although the outcomes of triangular resection were better than those with quadrangular resection, a 2-mm reduction in coaptation length and a 2- to 3-mm posterior displacement of the leaflet coaptation was measured in comparison with the control group.…”

Section: Discussionmentioning

confidence: 52%

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

Padala

Powell

Croft

et al. 2009

The Journal of Thoracic and Cardiovascular Surgery

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Objective Leaflet prolapse resulting from acute chordal rupture is one presentation of fibroelastic deficiency that is associated with minimal leaflet changes in the prolapsing segment. Minimizing resection and preserving leaflet tissue may be an optimal surgical strategy. We examined the importance of the leaflet preservation concept by comparing resective and nonresective surgical procedures in practice today. Methods Eight porcine mitral valves were evaluated in an in vitro heart simulator before surgical manipulation. Mitral regurgitation was created in these valves by transecting the posterior marginal chordae resulting in severe P2 prolapse. After confirmation of mitral regurgiation via regurgitant flow measurement (mL/beat), regurgitation was corrected by three repairs: neochordoplasty with polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Flagstaff, Ariz), triangular resection, and quadrangular resection with annular compression. Post-repair valve hemodynamics were quantified under pulsatile conditions of 120 mm Hg peak transmitral pressure and 5 L/min cardiac output at 70 beats/min. Furthermore, hemodynamic, geometric, and echocardiographic indices were measured. Results Transecting the marginal chordae resulted in severe P2 prolapse and significant mitral regurgiation (19.3 ± 4.3 mL/beat). Regurgitant volume was significantly reduced after any of the three surgical approaches (quadrangular, 4.38 ± 1.6 mL/beat; triangular, 2.56 ± 1.0 mL/beat; neochordal, 2.86 ± 1.24 mL/beat). In comparison with the baseline normal valves, leaflet coaptation length and posterior leaflet mobility were significantly reduced in the quadrangular resection group, whereas they were partially restored in the triangular resection and fully preserved in the neochordoplasty group. Conclusions Although the three repair procedures are hemodynamically comparable, valve function and leaflet kinematics were significantly better after a nonresection or limited resective correction of leaflet prolapse in this experimental model of acute chordal rupture with otherwise normal leaflet geometry.

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Section: Discussionmentioning

confidence: 52%

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

Padala

Powell

Croft

et al. 2009

The Journal of Thoracic and Cardiovascular Surgery

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“…This criticism is only partially overwhelmed by a triangular resection. 8,19 A proper approach is addressed to limit as much the resection of redundant tissue from the PML to restore annular dimension and shape and eventually to replace lost structures (ie, chordae tendinae).…”

Section: Discussionmentioning

confidence: 99%

Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse

Col

Perticoni

Ramoni

2015

Innovations�(Phila)

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Objective Although effective, Carpentier technique for mitral regurgitation presents two “Achille's heel”: the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented. Methods Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure. Results Up to 9 years of follow-up was 98% complete. One inhospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility. Conclusions The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.

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“…(b) In the case of a large prolapsing posterior mitral leaflet with excessive leaflet height, Points a and b will be brought down to a different point on the posterior mitral annulus with annular plication. After triangular resection, the posterior mitral leaflet folding technique, described by Da Col et al [16] and Suri et al [17] are pictured. (c) In the case of a prolapsing posterior mitral leaflet with a limited extent, the leading edge is folded down a little after a triangular resection of the middle posterior mitral leaflet is performed with an additional pair of neochordae inserted; technique by Da Col et al [16] (d) In the case of the tall remaining lateral and medial border after a triangular resection of the middle posterior mitral leaflet, the leading edge is folded down in half without neochordae insertion, resulting in the ventricularization of the atrial side of the leaflet; technique by Suri et al [17] Without leaflet resection and annular plication, the posterior mitral leaflet horizontally folding technique without the change of native coaptation line, as described by Calafiore et al [7] and Hashim et al [8] are shown.…”

Section: Discussionmentioning

confidence: 99%

“…2a, b). Da Col et al [16] and Suri et al [17] performed a modified technique which involved flipping the margin over (i.e., PML ventricularization) after minimal triangular resection was performed with additional neochordae insertion or annuloplasty ring to prevent stiff movement of PML resulting from the wide resection associated with annular plication (Figures 2c, d). …”

Section: Discussionmentioning

confidence: 99%

Early results of non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse

Yeon¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin erken dönem sonuçları bildirildi. Ça lış ma pla nı: Kasım 2011 -Mart 2016 tarihleri arasında posterior mitral kapak orta segment prolapsusu için rezeksiyonel olmayan, dikey katlı mitral kapak tamiri yapılan ardışık 32 hastanın (18 erkek, 14 kadın; ort. yaş: 61.3±12.5 yıl; dağılım 43-75 yıl) verileri retrospektif olarak incelendi. Bul gu lar: Medyan takip süresi 33 ay (dağılım, 3-48 ay) idi. Hiçbir hastada replasman gerektiren tamir başarısızlığına rastlanmadı. Takip süresince, neredeyse hastaların hiçbirinde (n=31, %96.9) mitral yetmezliğin derecesinde kötüleşme görülmedi. So nuç: Çalışma sonuçlarımız posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin cerrahi süresini harcamadan kolaylık, geriye döndürülebilirlik ve tekrar edilebilirlik gibi çeşitli avantajları olduğunu göstermektedir. Özellikle deneyimi az cerrahlar için bu teknik değerli bir alternatif olup, teknik araç olarak akılda bulundurulmalıdır. Results:The median follow-up was 33 months (range, 3 to 48 months). Repair failure requiring replacement did not occur in any patient. During follow-up, nearly none of the patients (n=31, 96.9%) experienced aggravation of the degree of mitral regurgitation. Conclusion:Our study results show that non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse has several advantages such as simplicity, reversibility, and reproducibility without consuming surgical time. In particular, for surgeons with a limited experience, this technique is a valuable alternative and should be considered as a technical armamentarium.

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Triangular Resection and Folding of Posterior Leaflet for Mitral Valve Repair

Cited by 18 publications

References 4 publications

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

Mitral valve hemodynamics after repair of acute posterior leaflet prolapse: Quadrangular resection versus triangular resection versus neochordoplasty

Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse

Early results of non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse

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