Posterior Leaflet Shortening to Correct Systolic Anterior Motion After Mitral Valve Repair

Degenerative mitral regurgitation due to posterior leaflet prolapse is often associated with tissue redundancy in the leaflet height and free margin of the prolapsing segment. The butterfly technique has been introduced for focal resection to precisely control the leaflet height without annular plication. This technique is indicated for a high prolapsing leaflet, greater than 20 mm. With intraoperative measurement of leaflet heights and ink dot marking as a depth indicator, the butterfly technique can be safely performed in most high posterior leaflet prolapse cases, without increasing the risk of systolic anterior motion.

Download Full-text

Robotic Septal Myectomy and Mitral Valve Repair for Idiopathic Hypertrophic Subaortic Stenosis with Systolic Anterior Motion

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000249 ◽

2016 ◽

Vol 11 (2) ◽

pp. 146-149 ◽

Cited By ~ 1

Author(s):

Selin Bayburt ◽

Sahin Senay ◽

Ahmet Umit Gullu ◽

Muharrem Kocyigit ◽

Gultekin Karakus ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Interventricular Septum ◽

Posterior Wall ◽

Subaortic Stenosis ◽

Systolic Anterior Motion ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy

Combined therapeutic approach with performing mitral valve repair may be necessitated for the treatment of idiopathic hypertrophic subaortic stenosis (IHSS) with systolic anterior motion. This report includes operative technique for combined robotic septal myectomy and mitral valve repair. A 45-year-old man with IHSS was admitted to our center for surgical intervention. The transthoracic echocardiography showed typical asymmetric ventricular hypertrophy. Left ventricle posterior wall thickness was 11 mm, and interventricular septum thickness was 21 mm. Mitral valve leaflets were found to be elongated. Mild-to-severe mitral regurgitation was detected with eccentric mitral jet. Aortic peak gradient was 128 mm Hg. Robotic mitral repair and septal myectomy through left atrial exposure was performed. The anterior leaflet was detached, and the septal muscle in a mass of 1 × 0.7 × 0.5 cm was resected. Next, the anterior leaflet was reattached with continuous suture. The plication of the posterior leaflet with transverse incision was performed to diminish the length of posterior leaflet. After the magic suture for posteromedial commissure was performed, a 34 Medtronic Future ring was implanted for mitral annuloplasty. Postoperative course was uneventful. The patient was discharged on the sixth postoperative day. Combined robotic septal myectomy and mitral valve repair for IHSS with systolic anterior motion may be feasible.

Download Full-text

Off-Pump NeoChord Mitral Valve Repair to Simultaneously Treat Posterior Leaflet Prolapse and Systolic Anterior Motion

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.05.052 ◽

2017 ◽

Vol 103 (1) ◽

pp. e29-e30 ◽

Cited By ~ 2

Author(s):

Stefano Salizzoni ◽

Matteo Marro ◽

Chiara Rovera ◽

Giovanni Speziali ◽

Mauro Rinaldi

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Systolic Anterior Motion ◽

Posterior Leaflet ◽

Valve Repair ◽

Off Pump ◽

Leaflet Prolapse

Download Full-text

ECHOCARDIOGRAPHY PREDICTORS OF SUCCESSFUL MITRAL VALVE REPAIR IN DEGENERATIVE MITRAL VALVE REGURGITATION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.4_5.10 ◽

2015 ◽

pp. 77-82

Author(s):

Ba Minh Du Le ◽

Anh Vu Nguyen ◽

Duc Phu Bui

Keyword(s):

Mitral Valve ◽

Transesophageal Echocardiography ◽

Success Rate ◽

Mitral Valve Repair ◽

Transthoracic Echocardiography ◽

Mitral Valve Prolapse ◽

Posterior Leaflet ◽

Valve Repair ◽

Mitral Repair ◽

Fibroelastic Deficiency

Background and aim of the study: Mitral repair is now as the treatement of choice in patients suffering mitral regurgitation due to mitral valve prolapse or flail. However, mitral valve repair demands the mitral valve morphology being feasible for repair. The study aims at evaluating transthoracic and transesophageal echocardiographic features in consecutive patients with mitral valve prolapse or flail undergoing surgical repair at Hue Central Hospital. The correlation between preoperative and intraoperative echocardiographic features and surgical findings in these patients. These echocardiographic data may predict the surgical outcome. Methods: From December 2010 to January 2013, 73 patients (37 men, 36 women; average age 37.5) were recruited into the study. All patients had degenerative mitral valve disease causing important regurgitation and underwent systematic preoperative transthoracic echocardiography, preoperative and intraoperative transesophageal echocardiography for delineation of six segments (scallops) of anterior and posterior leaflets. Results: Among 73 patients, 64 patients were in fibroelastic deficiency (87.7%) and 9 patients suffered Barlow disease (12.3%). Mitral valve repair was performed in 52 patients (71.2%) and mitral replacement was performed in 21 patients (28.8%). All 52 mitral valve repair (81.3%) and 12 mitral valve replacement (18.7%) was performed in fibroelastic deficiency patients. All 9 Barlow patients must undergo mitral valve replacement (100%). A prolapse or flail of mitral valve in 73 patients was documented by transthoracic and transesophageal echocardiography and confirmed on surgical inspection. Accuracy of transthoracic echocardiography was (89.0%) and accuracy of transesophageal echocardiography was (91.8%) in identifying mitral valve segments prolapse or flail. Success rate of mitral valve repair was (98.0%) in prolapse of 1 or 2 segments, but was low (36.0%) in prolapse > 3 segments. Success rate of mitral valve repair was (96.6%) in prolapse of posterior leaflet, but was (63.6%) in prolapse anterior leaflet or bileaflet. Conclusion: - Mitral valve repair was favorable in fibroelastic deficiency patients, but difficult in Barlow patients. - Accuracy of transthoracic and transesophageal echocardiography was high in identifying mitral valve segments prolapse or flail. - Success rate of mitral valve repair was high in prolapse of 1 or 2 segments. - Success rate of mitral valve repair was high in in prolapse of posterior leaflet. Key words: Mitral repair, echocardiography, degenerative, Barlow, fibroelastic deficiency, prolapse, flail

Download Full-text

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519841292 ◽

2019 ◽

Vol 14 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Burak Onan ◽

Ersin Kadirogullari ◽

Zeynep Kahraman ◽

Onur Sen

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Da Vinci Surgical System ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy ◽

Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

Download Full-text

Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2005.09.040 ◽

2006 ◽

Vol 131 (2) ◽

pp. 364-370 ◽

Cited By ~ 65

Author(s):

Michele De Bonis ◽

Roberto Lorusso ◽

Elisabetta Lapenna ◽

Samer Kassem ◽

Giuseppe De Cicco ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Long Term Results ◽

Posterior Leaflet ◽

Valve Repair ◽

Leaflet Prolapse

Download Full-text

Optimizing P2 Neochordal Length and Stability in Mitral Valve Repair With Use of a Polypropylene Loop

Texas Heart Institute Journal ◽

10.14503/thij-18-6913 ◽

2020 ◽

Vol 47 (3) ◽

pp. 207-209

Author(s):

Anil Ozen ◽

Ertekin Utku Unal ◽

Hamdi Mehmet Ozbek ◽

Gorkem Yigit ◽

Hakki Zafer Iscan

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Severe Mitral Regurgitation ◽

Posterior Leaflet ◽

Valve Repair ◽

Chordae Tendineae ◽

Optimal Length ◽

Precise Method ◽

Artificial Chordae

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

Download Full-text