Document Detail


Neochordal repair of the posterior mitral leaflet.
MedLine Citation:
PMID:  14762353     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Myxomatous mitral valve insufficiency is traditionally repaired by posterior leaflet quadrangular resection and reconstruction. A simplified repair technique without leaflet resection is described, and our initial experience is reviewed. METHODS: Thirty-nine consecutive patients with significant mitral regurgitation underwent repair since January 2000 by placement of expanded polytetrafluoroethylene sutures between the leading (coapting) edge of the posterior leaflet and the corresponding papillary muscle. An annuloplasty ring was placed, and no leaflet tissue was resected. Patient medical records were obtained and retrospectively reviewed. RESULTS: Twenty-five men and 14 women (median age, 61 years; range, 40-88 years) had their mitral valve repaired by a variety of surgical approaches, including robotic (18 patients), right thoracotomy (6 patients), and sternal (15 patients). Three patients have required valve replacement: 1 at the initial operation, 1 because of dehiscence of the annuloplasty ring, and 1 after subsequent rupture of a previously normal native chorda. At follow-up (median, 12 months), 92% (33/36) of the remaining patients had an intact mitral repair with no to mild regurgitation, 8.3% (3/36) of patients had moderate regurgitation, and 92% of all patients (36/39) were in New York Heart Association class I. There were no deaths. CONCLUSIONS: Myxomatous mitral regurgitation due to posterior leaflet insufficiency can be repaired without leaflet resection by placement of neochordae. This repair technique is effective and is readily accomplished by traditional and minimally invasive surgical approaches.
Authors:
John J Nigro; Daniel S Schwartz; Robert D Bart; Candace W Bart; Becky M Lopez; Mark J Cunningham; Mark L Barr; Ross M Bremner; Steven M Haddy; Winfield J Wells; Vaughn A Starnes
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-05     Completed Date:  2004-05-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  440-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA. jnigro@chla.usc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Coronary Artery Disease / epidemiology,  surgery,  ultrasonography
Echocardiography
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation*
Humans
Length of Stay
Male
Middle Aged
Mitral Valve Insufficiency / epidemiology,  surgery*,  ultrasonography
Mitral Valve Prolapse / epidemiology,  surgery*,  ultrasonography
Morbidity
Postoperative Complications / epidemiology,  etiology,  surgery
Recurrence
Reoperation
Retrospective Studies
Robotics
Severity of Illness Index
Treatment Outcome
Ventricular Dysfunction, Left / epidemiology,  surgery,  ultrasonography

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


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