Butterfly technique in mitral valve repair

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.

scholarly journals P1412 A new light to improve the view of the anatomical details during micro-invasive trans-ventricular repair of degenerative prolapse of mitral valve

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Vairo ◽  
M Marro ◽  
G Speziali ◽  
M Rinaldi ◽  
S Salizzoni
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Coming Out ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Valve Repair ◽  
High Definition ◽  
Definition Of ◽  
Leaflet Prolapse

Abstract BACKGROUND Mitral valve repair is the preferred surgical treatment for severe mitral regurgitation due to degenerative leaflet prolapse. Within the growing era of transcatheter treatments for valvular heart disease, an innovative micro-invasive trans-ventricular beating-heart procedure was developed. Three-dimensional (3D) transoesophageal echocardiographic guidance is crucial to assist the operator in instrument navigation and chords positioning. 3D ultrasound technology is constantly evolving and a special light, that can be mobilized within the 3D images, has recently been invented. This light allows to illuminate the structures from different points of view and increase the definition of the anatomical details. PURPOSE To show the advantages of this new 3D image analysis technology, described above, through a sequence of intra-procedural images of a mitral valve repair by trans-ventricular polytetrafluoroethylene (ePTFE) chords implantation. METHODS The procedure is performed using a device that is introduced through a posterolateral ventriculotomy and it is advanced towards the mitral valve under real-time 3D transoesophageal guidance. The prolapsing segment, in this case central part of posterior leaflet (Fig. 1 A, B and C), is grasped with the jaw of the instrument (J in Fig. 1D), then the chords are implanted, tensioned and secured outside the ventricle. Figure 1A shows the pre-operative image of posterior leaflet prolapse with flail (P2 segment) and the light illuminates the valve from above. The broken chords (arrow in Fig. 1A) can be recognized with high definition. The light can also be placed on the valve plane (Fig. 1B) or below (Fig. 1C). When illumination occurs from the left ventricular side, the coaptation loss due to the P2 flail is highlighted (arrow in Fig. 1C). After placement, tensioning and securing the chords outside the ventricle, the prolapse disappears and the correct coaptation is re-established (Fig. 1E). The coaptation deficit is no longer visible, even with the light placed below the valve and it is possible to see the light coming out of the aortic valve (Ao), opened in systole, with mitral valve closed (Fig. 1F). RESULTS At the end of the procedure the residual mitral regurgitation was trivial and no loss of coaptation can be evidenced even with the light placed in the left ventricle (Fig. 1F). CONCLUSIONS This new light allows to improve the anatomical definition of 3D echocardiographic images, allows better visualization of the coaptation defects and can be used as a further verification of the result especially in cases of micro-invasive mitral repair. Abstract P1412 Figure 1

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

2017 ◽  
Vol 103 (1) ◽  
pp. e29-e30 ◽  
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

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

2006 ◽  
Vol 131 (2) ◽  
pp. 364-370 ◽  
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

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.

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