211311 Surgical treatment of anterior mitral valve prolapse using artificial chordal loop

/Li Jiyong(李繼勇，Dept Cap Med Univ，Beijing Inst Heart，Lung，Blood Vessel Disease，Beijing Anzhen Hosp，Cap Med Univ，Beijing 100029)…∥Chin J Thorac Cardiovasc Surg.-2010，26(6).-365～367

ObjectiveTo summarize clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop.MethodsFrom January 2008 to August 2009，pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients，5 males and 3 females，aged from 28 to 68(average 56.0 ±8.9)years.The heart function(NYHA)was classⅡin 2 patients and classⅢin 6.Echocardiography showed chordal rupture in 7 patients，2 with chordal rupture and elongation and pure chordal elongation in 1.There were 3 patients with A1 segment prolapse of anterior mitral leaflet，2 with A2 segment prolapse，3 with both A2 and A3 segments prolepses by Carpentier standardization.There were 2 patients with posterior leaflet chordal rupture in P2 and P3 segment，1 with cor triatrium.Left ventricular end diastolic diameter(LVEDD)was 53-62 mm ［average(57.2± 3.8)mm］.Ejection fraction(EF)was 0.60-0.68(average 0.63 ±0.02).Heart-thoracic ratio was 0.52 ±0.17.We measured the normal chordal using both a caliber and by echocardiography(for comparison after operation).The artificial chordal loops was constructed on the caliber using ePTFE suture，and then fixed the loop to the papillary muscle and the free edge of the anterior leaflet.ResultsThere was no operation death.Hemolysis after 2 days of operation in 1 patient was amended by alkalinization，diuresis and hormone treatment.Pre-discharge transthoracic echocardiography showed mild regurgitation in 1patient，trivial regurgitation in 7.LVEDD were 42-51mm ［average(47.1 ±2.2)mm］significantly decreased than that of pre-operation.Following parameters were measured and compared with pre-operation:EF 0.58 ±0.03 vs.0.63 ±0.02，heart function(NYHA)class 1.25 ± 0.42 vs.2.75 ±0.58.Normal chordal length measured by caliber was(21.20 ± 1.55)mm vs.(22.10 ± 2.68)mm by echocardiography.Anticoagulation therapy with warfarin was for 3 months after discharge and all the patients followed-up ［1-19 months，average(8.2 ±4.3)months］.Post operative echocardiography showed mild regurgitation in 1 patient，no or trivial regurgitation in 7 patients.The heart function class was evidently improved compared with pre-operation:6 patients in classⅠ，2 patients in classⅡ.ConclusionThe pre-measured ePTFE loop is reliable and reproducible confirmed by short-term follow-up for treating anterior leaflet prolapse.13 refs，1 fig，1 tab.