Document Detail


Comparison of artificial neochordae and native chordal transfer in the repair of a flail posterior mitral leaflet: an experimental study.
MedLine Citation:
PMID:  23291143     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgical reconstruction of a flail posterior leaflet is a routine mitral valve repair, the techniques for which have evolved from leaflet resection to leaflet preservation. Artificial expanded polytetrafluoroethylene neochordae are frequently used to stabilize the flail leaflet and seldom, translocation of the native secondary chordae of the valve to the leaflet free edge is used. In this study, we sought to investigate the efficacy of the 2 techniques to correct posterior leaflet prolapse and reduce mitral regurgitation, and quantify the acute post repair leaflet kinematics.
METHODS: Adult porcine mitral valves (n =7) were studied in a pulsatile left heart experimental model in which isolated P2 flail was mimicked by marginal chordal transection. Baseline conditions were established in each valve under normal conditions (control) and were followed by induction of isolated P2 flail by transecting the 2 marginal chordae on the posterior leaflet free edge (disease). The flail posterior leaflet was reconstructed using artificial neochordae (repair 1) and then native chordal translocation (repair 2). Reduction in leaflet flail, changes in mitral regurgitation fraction, leaflet coaptation length, and posterior leaflet mobility were measured using B-mode echocardiography or color Doppler.
RESULTS: At baseline, all the valves were competent with no mitral regurgitation. After transection of the marginal chordae on the posterior leaflet, isolated P2 flail was evident with 13.7% ± 13% regurgitation. Reconstruction with artificial neochordae eliminated leaflet flail and reduced mitral regurgitation to 3.2% ± 2.8%, and with chordal translocation leaflet flail was corrected and mitral regurgitation was measured at 2.3% ± 2.6%. Using either repair techniques, leaflet coaptation and mobility of the repaired leaflets were adequate and comparable with the baseline measurements.
CONCLUSIONS: Comparable reduction leaflet flail and regurgitation, and restoration of physiologic leaflet coaptation with the 2 techniques indicate that under acute conditions, use of artificial neochordae or native chordal translocations have similar benefits.
Authors:
Muralidhar Padala; Benedicte Cardinau; Lazarina I Gyoneva; Vinod H Thourani; Ajit P Yoganathan
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-03
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  95     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-22     Completed Date:  2013-03-26     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  629-33     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cardiac Surgical Procedures / methods
Chordae Tendineae / transplantation*
Mitral Valve / surgery*
Mitral Valve Insufficiency / surgery*
Polytetrafluoroethylene*
Swine
Grant Support
ID/Acronym/Agency:
R01 HL090661/HL/NHLBI NIH HHS; R01-HL090661/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene
Comments/Corrections
Comment In:
Ann Thorac Surg. 2013 Feb;95(2):633-4   [PMID:  23336875 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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