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Posterior mitral annuloplasty for enhancing mitral leaflet coaptation: using a strip designed for placement in the posterior annulus.

Kim JH, Kim KH, Choi JB, Kuh JH - J Cardiothorac Surg (2015)

Bottom Line: Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15).PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions.It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. kim77jh@gmail.com.

ABSTRACT

Background: In patients with mitral valve regurgitation (MR), posterior mitral annuloplasty (PMA) was performed for mitral valve repair using a strip designed for placement in the posterior annulus, sparing the anterior annulus and anterior half of the commissures.

Methods: Between September 2009 and October 2013, we performed PMA using a novel strip in 74 consecutive patients with MR greater than 3+. Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15). All patients were analyzed by serial echocardiographic follow-up, and preoperative and postoperative computed tomography was performed in 10 randomly selected patients.

Results: Hospital death occurred in two patients (2.7 %), and 72 survived patients were completely followed up. At a mean follow-up of 37.2 ± 15.0 months, the MR grade was zero or 1+ in 64 patients (88.9 %), 2+ in 7 patients (9.7 %), and 3+ in one patient (1.4 %). The mean indexed valve area and mean valve gradient were 1.7 ± 0.4 cm(2)/m(2) and 3.5 ± 1.2 mmHg, respectively. The mean leaflet coaptation height in early systole was 12.8 ± 3.5 mm. During the cardiac cycle, the repaired valves exhibited dynamic changes of 19.5 ± 9.3 % in the septo-lateral dimensions. No early conversions to valve replacements or late reoperations occurred. None of the patients with remnant or recurrent MR experienced hemolysis.

Conclusions: PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions. It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.

No MeSH data available.


Related in: MedlinePlus

a The strip is placed using six interrupted 2–0 Dacron mattress sutures that are passed through the 5-mm left atrial wall and posterior annulus. b For mitral regurgitation due to commissural chordal rupture, new chord placement (white arrowhead) and strip annuloplasty (white arrow) were performed. c In the saline test, the leaflet coaptation (white arrow) was placed below the strip. A: anterior leaflet; P: posterior leaflet
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Fig2: a The strip is placed using six interrupted 2–0 Dacron mattress sutures that are passed through the 5-mm left atrial wall and posterior annulus. b For mitral regurgitation due to commissural chordal rupture, new chord placement (white arrowhead) and strip annuloplasty (white arrow) were performed. c In the saline test, the leaflet coaptation (white arrow) was placed below the strip. A: anterior leaflet; P: posterior leaflet

Mentions: The PMA procedure has been described in detail previously [5]. The MV was exposed under cardioplegic arrest with moderate hypothermic cardiopulmonary bypass. Prior to PMA, new chord placement was performed for anterior or posterior leaflet prolapse [6]. After a suitable strip size was determined, six braided 2–0 Dacron sutures were passed in inverted U-shapes through the supra-annular atrial wall (5 mm in length) and the posterior annulus from commissure to commissure (Fig. 2a). Both end sutures were placed at the middle portion of the commissural annulus. All sutures were passed through the middle gully of the strip and tied. After the strip was placed on the atrial wall along the posterior annulus, the annulus and strip became curvilinear due to the circular force of the annulus (Fig. 2b). In a saline test, the leaflet coaptation line was located below the strip, not at strip level (Fig. 2c). In cases of tethered posterior leaflets associated with rheumatic valve disease or ischemic MR or a narrow posterior leaflet < 10 mm in height, a sufficient leaflet area for coaptation was created by posterior leaflet augmentation. The posterior leaflet was detached from the posterior annulus, leaving 3-5 mm of intact leaflet tissue at both ends of the posterior leaflet, and the defect was augmented with an elliptical bovine pericardial patch 15 mm × 45 mm using running 5–0 polypropylene sutures.Fig. 2


Posterior mitral annuloplasty for enhancing mitral leaflet coaptation: using a strip designed for placement in the posterior annulus.

Kim JH, Kim KH, Choi JB, Kuh JH - J Cardiothorac Surg (2015)

a The strip is placed using six interrupted 2–0 Dacron mattress sutures that are passed through the 5-mm left atrial wall and posterior annulus. b For mitral regurgitation due to commissural chordal rupture, new chord placement (white arrowhead) and strip annuloplasty (white arrow) were performed. c In the saline test, the leaflet coaptation (white arrow) was placed below the strip. A: anterior leaflet; P: posterior leaflet
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4643521&req=5

Fig2: a The strip is placed using six interrupted 2–0 Dacron mattress sutures that are passed through the 5-mm left atrial wall and posterior annulus. b For mitral regurgitation due to commissural chordal rupture, new chord placement (white arrowhead) and strip annuloplasty (white arrow) were performed. c In the saline test, the leaflet coaptation (white arrow) was placed below the strip. A: anterior leaflet; P: posterior leaflet
Mentions: The PMA procedure has been described in detail previously [5]. The MV was exposed under cardioplegic arrest with moderate hypothermic cardiopulmonary bypass. Prior to PMA, new chord placement was performed for anterior or posterior leaflet prolapse [6]. After a suitable strip size was determined, six braided 2–0 Dacron sutures were passed in inverted U-shapes through the supra-annular atrial wall (5 mm in length) and the posterior annulus from commissure to commissure (Fig. 2a). Both end sutures were placed at the middle portion of the commissural annulus. All sutures were passed through the middle gully of the strip and tied. After the strip was placed on the atrial wall along the posterior annulus, the annulus and strip became curvilinear due to the circular force of the annulus (Fig. 2b). In a saline test, the leaflet coaptation line was located below the strip, not at strip level (Fig. 2c). In cases of tethered posterior leaflets associated with rheumatic valve disease or ischemic MR or a narrow posterior leaflet < 10 mm in height, a sufficient leaflet area for coaptation was created by posterior leaflet augmentation. The posterior leaflet was detached from the posterior annulus, leaving 3-5 mm of intact leaflet tissue at both ends of the posterior leaflet, and the defect was augmented with an elliptical bovine pericardial patch 15 mm × 45 mm using running 5–0 polypropylene sutures.Fig. 2

Bottom Line: Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15).PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions.It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. kim77jh@gmail.com.

ABSTRACT

Background: In patients with mitral valve regurgitation (MR), posterior mitral annuloplasty (PMA) was performed for mitral valve repair using a strip designed for placement in the posterior annulus, sparing the anterior annulus and anterior half of the commissures.

Methods: Between September 2009 and October 2013, we performed PMA using a novel strip in 74 consecutive patients with MR greater than 3+. Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15). All patients were analyzed by serial echocardiographic follow-up, and preoperative and postoperative computed tomography was performed in 10 randomly selected patients.

Results: Hospital death occurred in two patients (2.7 %), and 72 survived patients were completely followed up. At a mean follow-up of 37.2 ± 15.0 months, the MR grade was zero or 1+ in 64 patients (88.9 %), 2+ in 7 patients (9.7 %), and 3+ in one patient (1.4 %). The mean indexed valve area and mean valve gradient were 1.7 ± 0.4 cm(2)/m(2) and 3.5 ± 1.2 mmHg, respectively. The mean leaflet coaptation height in early systole was 12.8 ± 3.5 mm. During the cardiac cycle, the repaired valves exhibited dynamic changes of 19.5 ± 9.3 % in the septo-lateral dimensions. No early conversions to valve replacements or late reoperations occurred. None of the patients with remnant or recurrent MR experienced hemolysis.

Conclusions: PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions. It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.

No MeSH data available.


Related in: MedlinePlus