A Novel Design of Posterior Leaflet Butterfly Resection for Mitral Valve Repair

A new design for posterior leaflet resection, “butterfly resection,” is proposed. It is a combination of two triangular resections in the prolapsing posterior leaflet segment. This method minimizes resection in the target segment, and it prevents systolic anterior motion by reducing the height of the posterior leaflet according to the amount of excess tissue. We have used this technique for 60.4% (29 of 48) of posterior leaflet prolapse cases with zero hospital mortality and no morbidity. Postbypass transesophageal echocardiography identified no more than mild regurgitation and no sign of systolic anterior motion. During 13.1 ± 6.8 months of follow-up, patients neither died nor needed reoperation.

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Butterfly technique in mitral valve repair

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320916298 ◽

2020 ◽

Vol 28 (7) ◽

pp. 413-415

Author(s):

Tohru Asai

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Systolic Anterior Motion ◽

Posterior Leaflet ◽

Valve Repair ◽

Free Margin ◽

Leaflet Prolapse

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.

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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

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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

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