MO08. Repair of Posterior Leaflet Prolapse: "detachment and non-sliding plasty technique".
Presented During: Breakfast Abstract Video Session
ICBA
Buenos Aires, Buenos Aires
Argentina - Contact Me
Daniel Navia M.D. Chief Cardiac Surgery Dept. at Instituto Cardiovascular, Buenos Aires Argentina. Former Fellow in Cardiac Surgery at Cleveland Clinic (89-92). AATS member. Special interest in: offpump CABG, Aortic and Mitral valves repair.
Friday, May 5, 2023: 7:56 AM - 8:04 AM
8 Minutes
New York Hilton Midtown
Room: Grand Ballroom
Description
Objective: We describe an alternative surgical technique to treat severe mitral regurgitation due to a big (height and width =/> 3 cm) posterior leaflet prolapses.
Case Video Summary: A 65 years old female patient asymptomatic, in sinus rhythm with severe mitral regurgitation due to posterior leaflet prolapse, good ventricular function and no coronary lesions. Echocardiogram shows prolapse of posterior leaflet with chordal rupture at P2 level with an excess of tissue. Regurgitant jet anterior directed. Valve analysis identified small P1 one with no prolapse. A huge posterior leaflet prolapses with chordal rupture and with an excess tissue (height and width =/>3 cm) over P2 and P3. Anterior leaflet with no prolapse, a scar lesion secondary to an old infection process was identified with no leaflet perforation. We decide to detach almost the entire posterior leaflet from the annulus. In order to lower the height of the posterior leaflet we resect around a cm from the base of the leaflet. Without using sliding technique, we re-attach de posterior leaflet to the annulus with double running technique. Two set of PTFE neochords were place over posterior and anterior papillary muscles. Water test analysis without and with an incomplete posterior ring probe good results with posterior line of coaptation. Final length adjustment of the artificial chords was performed. Post operative echo shows no regurgitation with good surface of coaptation.
Conclusions: A huge posterior leaflet prolapse with an excess tissue (height and width =/> 3 cm) can be treated with detachment, resection and re-attachment to the annulus, without the use of sliding technique.
Case Video Summary: A 65 years old female patient asymptomatic, in sinus rhythm with severe mitral regurgitation due to posterior leaflet prolapse, good ventricular function and no coronary lesions. Echocardiogram shows prolapse of posterior leaflet with chordal rupture at P2 level with an excess of tissue. Regurgitant jet anterior directed. Valve analysis identified small P1 one with no prolapse. A huge posterior leaflet prolapses with chordal rupture and with an excess tissue (height and width =/>3 cm) over P2 and P3. Anterior leaflet with no prolapse, a scar lesion secondary to an old infection process was identified with no leaflet perforation. We decide to detach almost the entire posterior leaflet from the annulus. In order to lower the height of the posterior leaflet we resect around a cm from the base of the leaflet. Without using sliding technique, we re-attach de posterior leaflet to the annulus with double running technique. Two set of PTFE neochords were place over posterior and anterior papillary muscles. Water test analysis without and with an incomplete posterior ring probe good results with posterior line of coaptation. Final length adjustment of the artificial chords was performed. Post operative echo shows no regurgitation with good surface of coaptation.
Conclusions: A huge posterior leaflet prolapse with an excess tissue (height and width =/> 3 cm) can be treated with detachment, resection and re-attachment to the annulus, without the use of sliding technique.
Presentation Duration
5-minute presentation; 3-minute discussion