Document Detail

Chordal cutting VIA aortotomy in ischemic mitral regurgitation: surgical and echocardiographic study.
MedLine Citation:
PMID:  18290888     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chordal cutting through atriotomy has been proposed to treat significant resting ischemic mitral regurgitation (MR) due to anterior leaflet tenting. In addition, MR may exacerbate during exercise not only trough exercise-induced ischemia but also through an increase in tenting area. Accordingly, we aimed to perform chordal cutting through aortotomy in patients with exercise-induced ischemic worsening of MR. METHODS: Five patients with ischemic MR, due to anterior leaflet tenting, which worsened during exercise echocardiography were enrolled. All patients underwent cutting of the 2 basal chordae attached to the anterior mitral leaflet associated with myocardial revascularization. Three patients had additional mitral valve annuloplasty. Postoperative MR was evaluated using exercise echocardiography. RESULTS: Age ranged from 63 to 78 years and 4 patients were male. Preoperative LV ejection fraction averaged 39 +/- 3%. Chordal cutting was performed through aortotomy allowing comfortable access to the anterior mitral valve. Mitral effective regurgitant orifice at rest and at peak exercise was reduced by surgery (10 +/- 3 to 0.6 +/- 0.5 mm(2) at rest and from 20 +/- 3 to 6 +/- 2 mm(2) at peak exercise; p = 0.03). Mitral tenting area at rest and at peak exercise was concomitantly reduced by surgery (1.83 +/- 0.21 cm(2) to 0.50 +/- 0.4 cm(2) at rest and from 3.11 +/- 0.58 to 1.7 +/- 0.5 cm(2) at peak exercise; p = 0.03). Left ventricular size and function remained unchanged after surgery. CONCLUSIONS: Chordal cutting through aortotomy may be an effective option to treat ischemic MR due to anterior leaflet tenting. Associated with myocardial revascularization, it resulted in a decrease of MR at rest and during exercise through a decrease in tenting area without impairment of LV function.
Georges Fayad; Sylvestre Maréchaux; Thomas Modine; Richard Azzaoui; Benoît Larrue; Pierre-Vladimir Ennezat; Hakim Bekhti; Christophe Decoene; Ghislaine Deklunder; Thierry Le Tourneau; Henri Warembourg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  23     ISSN:  0886-0440     ISO Abbreviation:  J Card Surg     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-02-22     Completed Date:  2008-07-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-7     Citation Subset:  IM    
Cardiovascular Surgery Department, University Hospital, Lille, France.
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MeSH Terms
Aorta / anatomy & histology,  surgery,  ultrasonography
Cardiac Surgical Procedures / methods*
Chordae Tendineae / surgery*
Middle Aged
Mitral Valve / anatomy & histology,  surgery,  ultrasonography
Mitral Valve Insufficiency* / surgery,  ultrasonography
Myocardial Ischemia / etiology,  surgery
Stroke Volume / physiology
Treatment Outcome

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