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European Journal of Cardio-Thoracic Surgery, Vol 11, 268-273, Copyright © 1997 by European Association for Cardio-thoracic Surgery
M Salati, S Moriggia, R Scrofani and C Santoli
OBJECTIVE: Chordal transposition was advocated for correction of anterior
mitral prolapse. We have evaluated the early and late results of this
technique in different anatomical presentations. METHODS: From 1986 to
1995, 185 mitral valve repairs were carried out for pure mitral
regurgitation due to a degenerative disease. Eighty-nine patients had
either an anterior prolapse (39) or prolapse of both leaflets (50) at
initial presentation and underwent chordal transposition from the mural
leaflet to the anterior leaflet. The corrective procedure was completed by
polytetrafluoroethylene or pericardial posterior annuloplasty. Twenty
patients presented a complex pathology and 26 had chordal elongation of
mural leaflet. Annular calcifications were found in 9 patients. Seven
patients required shortening of transposed chordae and two patients the
additional shortening of an anterior chorda. RESULTS: Operative mortality
was 3.3% and follow-up was 95% complete (average 41 months). There were
five postreconstruction valve replacements (two earlier and three later)
for a probability of freedom from late reoperation or 3+ mitral
regurgitation of 88.6 +/- 4.8% at 5 years. Of the patients 79% presented no
or trivial residual MR, 17% moderate MR and 4% severe MR. The presence of a
complex pathology or posterior chordal elongation did not influence the
entity of postoperative residual regurgitation. On the contrary, the
patients with annular calcifications had a residual regurgitation/left
atrium area ratio greater than patients without annular calcification (15.8
+/- 11.5% vs. 6.1 + 9.9%; P = 0.009). CONCLUSIONS: Chordal transposition is
an effective and easily carried out technique for the correction of
anterior mitral prolapse. The presence of a complex pathology or posterior
chordal elongation do not rule out the procedure. The absence of annular
calcification is important in order to obtain a satisfactory correction.
ARTICLES
Chordal transposition for anterior mitral prolapse: early and long-term results
Division of Thoracic and Cardiovascular Surgery, L Sacco Hospital, Milan, Italy.
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