scholarly journals Preoperative determination of artificial chordae tendineae length by transoesophageal echocardiography in totally endoscopic mitral valve repair

2020 ◽  
Vol 31 (1) ◽  
pp. 20-27
Author(s):  
Antonios Pitsis ◽  
Nikolaos Tsotsolis ◽  
Efstratios Theofilogiannakos ◽  
Harisios Boudoulas ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Transoesophageal Echocardiography ◽  
Stereoscopic Vision ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Artificial Chordae

Abstract OBJECTIVES Artificial chordae tendineae are widely used for surgical repair in patients with mitral regurgitation due to floppy mitral valve/mitral valve prolapse. Expanded polytetrafluoroethylene has been used to construct these artificial chordae; however, the determination of the optimal length of the chordae prior to surgery has been an issue. For this reason, such a method was developed and the results of its use are presented. METHODS Forty-seven consecutive patients with significant mitral regurgitation due to floppy mitral valve/mitral valve prolapse who underwent totally endoscopic mitral valve surgery were studied. The chordae length was predetermined using transoesophageal echocardiography. The length between the top of the fibrous body of the papillary muscle and the coaptation line of the 2 leaflets of the mitral valve was measured and used to define the length of the chordae to be used for repair. Then under stereoscopic vision, a total endoscopic mitral valve repair was performed. RESULTS The predicted mean length of chordal loops was 19.76 ± 0.71 mm (median 20, range 16–28) and the actual mean length of chordal loops used was 19.68 ± 0.74 mm (median 20, range 16–26) demonstrating an excellent correlation between the two (r = 0.959). The mean number of chordae loops used per patient was 5.12 ± 0.62 (median 4, range 2–12). All patients at the time of discharge had no or trivial mitral regurgitation on transoesophageal echocardiography. CONCLUSIONS The chordae length used for mitral valve repair can be determined prior to surgery using transoesophageal echocardiography with a high degree of accuracy. Further, total endoscopic repair in this group of patients provides excellent results. For these reasons, it is expected that this method will replace most traditional approaches to cardiac surgeries in the years to come.

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

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.

P6489Preoperative determination of artificial chordae length by transesophageal echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pitsis ◽  
N Tsotsolis ◽  
E Theofilogiannakos ◽  
H Boudoulas ◽  
K Boudoulas
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Pearson Correlation ◽  
Transoesophageal Echocardiography ◽  
Valve Repair ◽  
Bottom Part ◽  
Artificial Chordae ◽  
The Mean

Abstract The use of artificial chordae is one of the main techniques used in mitral valve repair to treat prolapsing leaflets, especially in anterior and bileaflet prolapse. With the use of PTFE sutures to replace elongated or ruptured chords mitral valve repair rates have significantly improved. The main difficulty with this technique is to determine the optimal length of the artificial chordae. Intraoperative transoesophageal echocardiography (TOE) is mandatory in mitral valve repair in order to determine the type of lesion of the mitral valve but also to evaluate the quality of the repair. We examined the accuracy of preoperative prediction of artificial chordae length by the preoperativeTOE. Patients and methods Twenty-one consecutive patients (7 females) underwent mitral valve repair with artificial chordae for significant mitral valve prolapse in our department during the last year. The median age of the patients was 62 y. (range 25 - 87) and the mean EuroSCORE II 3,36% (SD 4,61%). During the prep TOE we determined the predicted length of the required replacement chordae for the repair using mainly the 4 chamber view to calculate the distance between the tip of the papillary muscle and the coaptation point of the two leaflets and we subtracted 5mm which is the minimum of the desired coaptation length (top right part of the Figure). All the patients underwent totally endoscopic mitral repair through a 3 cm right periareolar incision. 14,3% of the patients had anterior leaflet (AML) prolapse, 23,8% bileaflet and 61,9% posterior (PML). The appropriate length of the required chordae was measured intraoperatively. Results We used on average 3 loops of artificial chordae size 23,3 mm (SD 1,15mm) to treat the AML prolapse, 5 loops size 23,2 mm (SD 2,28mm) to treat the bileaflet prolapse and 2,23 loops size 18mm (SD 2mm) to treat the PML prolapse (bottom part of the figure). The predicted size of the artificial chordae had a positive correlation to the length used (Pearson correlation, p<0,001) as demonstrated in the top left part of the Figure. An annuloplasty band was implanted to all the patients. All the patients had no mitral regurgitation in the postoperative TOE. The mean valve area was 3,54cm2 (SD 0,57) and the mean peak gradient 5,6 mmHg (SD 1,82). There was no mortality. Chordae length predicted by echo Conclusion The length of artificial chordae can be predetermined with great accuracy with the use of TOE, making TOE an important tool not only for the determination of the mitral lesion and quality of the repair but also for the planning of the operation.

Idiopathic Acute Mitral Regurgitation Due to Chordal Rupture in Infants: Surgical Management and Results

2019 ◽  
Vol 10 (1) ◽  
pp. 37-41
Author(s):  
Kosuke Yoshizawa ◽  
Keiichi Fujiwara ◽  
Nobuhisa Ohno ◽  
Kentaro Watanabe ◽  
Hisanori Sakazaki
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Surgical Intervention ◽  
Valve Repair ◽  
Aortic Cross Clamp Time ◽  
Aortic Cross Clamp ◽  
Acute Mitral Regurgitation ◽  
Artificial Chordae

Objective: Emergency surgical treatment is required for idiopathic acute mitral regurgitation due to chordae rupture in infants. Nevertheless, mitral valve repair for such a patient population still remains challenging. We report our experience with mitral valve repair for idiopathic acute mitral regurgitation due to chordae rupture in infants. Methods: From 2005 to 2017, six infants (four boys) were diagnosed with acute mitral regurgitation due to chordae rupture and underwent mitral valve repair. The median age, mean body weight, and median follow-up period were 5.5 months (range: 4-9 months), 6.8 kg (range: 5.5-8.0 kg), and 6.4 years (range: 6 months to 10 years), respectively. Results: In all cases, surgical intervention was performed within 24 hours of admission. Artificial chordae reconstruction and paracommissural edge-to-edge repair were utilized in three and four cases, respectively, while Kay’s annuloplasty was performed in all cases. Mean cardiopulmonary bypass time and aortic cross-clamp time were 117 minutes (range: 70-143 minutes) and 73 minutes (range: 35-108 minutes), respectively. No early or late deaths and reoperations had occurred during the follow-up period. Moreover, postoperative mitral regurgitation was significantly reduced, while no chronologic progression of mitral regurgitation was observed. Conclusions: The combination of various techniques, such as artificial chordae reconstruction, paracomissural edge-to-edge repair, and Kay’s annuloplasty, can be a promising surgical option for idiopathic acute mitral regurgitation due to chordae rupture in infants.

scholarly journals Clinical results of mitral valve repair by reconstructing artificial chordae tendineae in children

1999 ◽  
Vol 118 (1) ◽  
pp. 94-98 ◽  
Author(s):  
Takashi Matsumoto ◽  
Hideaki Kado ◽  
Munetaka Masuda ◽  
Yuichi Shiokawa ◽  
Kouji Fukae ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Clinical Results ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Artificial Chordae

scholarly journals Totally endoscopic aortic valve replacement with concomitant trans-aortic mitral valve repair for mitral regurgitation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Antonios Pitsis ◽  
Nikolaos Tsotsolis ◽  
Harisios Boudoulas ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Surgical Aortic Valve Replacement ◽  
Secondary Mr

Abstract Background Minimally invasive aortic valve procedures through a hemi-sternotomy or a right anterior mini-thoracotomy have gained popularity over the last several years. Totally endoscopic aortic valve replacement (TEAVR) is an innovative and a less invasive (incision-wise) surgical aortic valve replacement technique. The operative steps of TEAVR have been reported previously from our group. Mitral regurgitation (MR) frequently accompanies aortic valve disease that at times may also require repair. Totally endoscopic surgery in such cases has not been tested. Presentation of the technique We present a surgical technique for a totally endoscopic approach to aortic valve replacement and concomitant mitral valve repair for primary and secondary MR. An aortotomy incision was used avoiding an atriotomy, which results in an increase in cross-clamp (XC) and cardiopulmonary bypass (CPB) times that could be associated with higher mortality and morbidity. Neochords (artificial chordae tendineae) were used for primary MR and an edge-to-edge approach for secondary MR. Conclusion TEAVR and concomitant mitral valve repair can be performed successfully with reasonable XC and CPB times with excellent short-term results.

Long-Term Results of Mitral Valve Repair for Severe Mitral Regurgitation in Infants: Fate of Artificial Chordae

2012 ◽  
Vol 94 (2) ◽  
pp. 581-586 ◽  
Author(s):  
Takashi Murashita ◽  
Takaya Hoashi ◽  
Koji Kagisaki ◽  
Kenichi Kurosaki ◽  
Isao Shiraishi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Long Term Results ◽  
Severe Mitral Regurgitation ◽  
Valve Repair ◽  
Artificial Chordae

scholarly journals Severe hemolytic anemia and acute renal failure after mitral valve repair associated with non-endothelialization of artificial chordae tendinae: case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jing Li ◽  
Qun-Jun Duan
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Hemolytic Anemia ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Mitral Repair ◽  
Artificial Chordae

Abstract Background Mechanical hemolytic anemia and acute renal failure are rare complications of mitral valve repair. Case presentation We report a unique case of severe hemolytic anemia and severe acute renal failure after mitral valve repair using artificial chordae tendinae. Conservative therapy including plasmapheresis and blood transfusion was not effective. The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. The hemolytic anemia resolved gradually after the replacement of mitral valve. The new artificial chordae tendinae was found to be completely non-endothelialized in the surgery. Non-endothelialization of artificial chordae tendinae may also play a role in the genesis of mechanical anemia. Conclusions The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. Non-endothelialization of foreign materials might be another mechanism of hemolysis after mitral repair.

scholarly journals Beating-heart, off-pump mitral valve repair by implantation of artificial chordae tendineae: An acute in vivo animal study

2009 ◽  
Vol 137 (1) ◽  
pp. 188-193 ◽  
Author(s):  
Pietro Bajona ◽  
William E. Katz ◽  
Richard C. Daly ◽  
Kenton J. Zehr ◽  
Giovanni Speziali
Keyword(s):  
Mitral Valve ◽  
Animal Study ◽  
Mitral Valve Repair ◽  
Beating Heart ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Off Pump ◽  
Artificial Chordae

Off-pump Transapical Mitral Valve Repair with Implantation of Neo-chordae

2011 ◽  
Vol 7 (3) ◽  
pp. 181
Author(s):  
Michael Hoebartner ◽  
Philipp Kiefer ◽  
Michael Andrew Borger ◽  
Friedrich Wilhelm Mohr ◽  
Joerg Seeburger ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Beating Heart ◽  
Severe Mitral Regurgitation ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Off Pump ◽  
Repair Procedure ◽  
Artificial Chordae

The authors present a case report of a mitral valve repair procedure featuring beating-heart, sternal-sparing implantation of neo-chordae. The 73-year-old female patient had severe mitral regurgitation (MR) pre-operatively, but no MR post-operatively and at 30-day follow-up. The patient was enrolled in the Transapical artificial chordae tendineae (TACT) trial sponsored by NeoChord Inc.

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