Refining visual estimation of artificial chordae length using low fidelity simulator in non-resection technique of mitral valve repair

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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The use of artificial chordae in mitral valve repair

Journal of Cardiac Surgery ◽

10.1111/jocs.13120 ◽

2017 ◽

Vol 32 (4) ◽

pp. 250-258 ◽

Cited By ~ 5

Author(s):

Li Wei ◽

Lihong Jiang ◽

Yaxiong Li

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Artificial Chordae

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A 20-year experience with mitral valve repair with artificial chordae in 608 patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.12.026 ◽

2008 ◽

Vol 135 (6) ◽

pp. 1280-1287.e1 ◽

Cited By ~ 99

Author(s):

Loris Salvador ◽

Salvatore Mirone ◽

Roberto Bianchini ◽

Tommaso Regesta ◽

Fabio Patelli ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Artificial Chordae

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

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118809076 ◽

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.

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P6489Preoperative determination of artificial chordae length by transesophageal echocardiography

European Heart Journal ◽

10.1093/eurheartj/ehz746.1079 ◽

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.

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