Belt And Braces Technique To Repair Anterior Leaflet Prolapse
Stefano Borsellino, Emiliano Navarra, Stefano Mastrobuoni, Laurent De Kerchove, Philippe Noirhomme, Gebrine El Khoury.
Cliniques Universitaires St. Luc – UcL – Brussels , Belgium, Brussels, Belgium.
Patient Demographics: Degenerative mitral valve regurgitations are often associated to the prolapse of one or both the mitral valve leaflets. The approach to the isolated anterior leaflet prolapse can be challenging and the choice of the appropriate technique is essential.
Relevant History: Here we report a case of a 61 year-old male patient, addressed to our institution for a worsening dyspnea and physical fatigue due a moderate isolated mitral regurgitation.
Pre-Operative Plan: Echocardiography, realized at the admission showed a grade 3 mitral regurgitation (Regurgitant volume = 50 ml/beat, ERO= 27 mm˛) due to the prolapse of the anterior leaflet at level of A2 and normal left ventricular ejection fraction (LVEF = 58%). Angiography showed normal coronary arteries.
Discussion of what was actually done and the challenges, deaths and complications encountered. (Unless case is still pending): The patient underwent a mitral valve repair through a median sternotomy and cardiopulmonary bypass. Mitral valve was repaired by the transposition of 2 native secondary chords from A2 body to the free-edge and reinforced with the implantation of 2 pairs of neo-chordae to A2. The repair was completed with an anuloplasty ring. Post-repair TEE showed no residual regurgitation. The clinical post-operative course was uncomplicated and the patient was discharged on eighth post-operative day. The association of neochordae implantation and secondary chordae transposition allows to achieve an optimal result in case of anterior leaflet prolapse. The transposition of the secondary chord is used to correct the prolapse and as reference for the length of the artificial chordae. Furthermore, the use of the two techniques could improve the durability of the repair.
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