| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ann Thorac Surg 2002;73:1020-1021
© 2002 The Society of Thoracic Surgeons
a Department of Surgery (2), Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
e-mail: aoyagi{at}med.kurume-u.ac.jp
To the Editor
In a recent issue of The Annals, Fasol and Joubert-Hübner [1] reported a technique of a triangular resection of the anterior mitral leaflet (AML) to repair isolated segmental AML prolapse. This technique was initially introduced by Carpentier, but it was later abandoned because of a high incidence of recurrent regurgitation [2]. However, in 1995, Colvin’s group [3] again emphasized the usefulness and reliability of this technique for treatment of prolapsing AML.
We employed this technique in 9 of 68 patients who underwent mitral valve repair for AML prolapse. During operation, isolated segmental prolapse of one of the three scallops of the AML was resected, and mitral annuloplasty with a prosthetic ring was performed. All patients survived operation, and were followed for a mean of 55 months. One patient died of a noncardiac cause 123 months after repair with the triangular resection technique. The remaining 8 patients were in New York Heart Association functional class I, postoperatively. One patient, who died late after surgery, as mentioned above, underwent a second repair for recurrent mital regurgitation due to rupture of a chordae tendineae 92 months after the initial repair. No patients experienced other valve-related complications during follow-up. The latest transthoracic Doppler echocardiograms performed after repair revealed that mitral regurgitation was absent or trivial in 6 patients and mild in 2. Mitral annuloplasty with a prosthetic ring was not performed in the 2 patients who had mild mitral regurgitation.
Quadrangular resection of the posterior mitral leaflet for mitral regurgitation resulting from segmental prolapse of the leaflet is a simple and reliable reparative procedure with excellent long-term results. However, repair of prolapse of the AML by triangular resection has been rarely used. The limited experiences reported so far have indicated that triangular resection of the AML can be safely performed [1, 3]. As previously described [3], an important factor for successful repair by this technique is approximation of leaflet margins without tension. Therefore, triangular resection of the AML should be limited to cases with redundant AML or to cases with segmental prolapse of one of the three scallops. On the other hand, triangular resection of the AML always produces a decrease in leaflet area available for competent closure and backward movement of the free margin of the AML. These facts greatly influence competence of the mitral valve, because they decrease the plane of coaptation between the two leaflets. To restore this plane to adequate coaptation of the leaflets, mitral annuloplasty with a prosthetic ring, which provides forward movement of the posterior mitral leaflet, is essential for success of this technique.
In conclusion, we believe that the technique of triangular resection of the AML can be safely used for patients with segmental prolapse of one of the three scallops, and that mitral annuloplasty with a prosthetic ring is essential for preventing recurrence of incompetence.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
