CAOXiang-rong , ZHANGJian-qun , LIJi-yong , ZHANGFu-en , SUNGuang-long
  • Beijing Institute of Heart Lung and Blood Vessel Disease & Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;
ZHANGJian-qun, Email: doczjq@126.com
Mitral valve prolapse; Artificial chordae; Loop; Caliper; Cardiac surgery
10.7507/1007-4848.20140055
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Objective To summarize our clinical experience of artificial chordal replacement with loop technique for the treatment of mitral insufficiency (MI) due to mitral valve prolapse. Methods From January 2008 to August 2011, pre-measured expanded polytetrafluoroethylene (ePTFE) loops were used for the treatment of MI in 22 patients in the Department of Cardiac Surgery,Beijing Anzhen Hospital. There were 15 males and 7 females with their age of 26-69(53.1±8.5) years. Six patients were in NYHA class Ⅱ and 16 patients were in NYHA class Ⅲ. There were 14 patients with anterior mitral leaflet chordal rupture,2 patients with anterior mitral leaflet chordal elongation,4 patients with both anterior and posterior mitral leaflet chordal rupture,and 2 patients with posterior mitral leaflet chordal rupture. All the patients had severe MI. One patient had concomitant cor triatriatum,and another patient had coronary heart disease. Left ventricular end-diastolic diameter (LVEDD) was 49-67 (58.1±3.9) mm,ejection fraction (EF) was 58%-69% (61.8±2.1%) and cardiothoracic ratio was 0.53±0.16. We measured the length of normal chordae adjacent to the ruptured or elongated chordae with a caliper for reference,and constructed the artificial chordal loops on the caliper with ePTFE suture according to the scope of mitral valve prolapse,then fixed the loops to the corresponding papillary muscles and free edge of the prolapsed mitral leaflets. Ring annuloplasty was routinely performed for all the patients. One patient received concomitant repair for cor triatriatum, and another patients underwent concomitant coronary artery bypass grafting. All the patients received oral anticoagulation with warfarin for 3 months after discharge. Results There was no in-hospital death. Postoperatively,1 patient had hemoglobinuria and another patient had wound infection,both of whom were cured after treatment. Pre-discharge echocardiography showed mild or no MI in 1 patients and trivial MI in 21 patients. Postoperative LVEDD was 43-53 (48.1±2.1) mm and significantly smaller than preoperative LVEDD. All the patients were follow up for 4-39 (18.3±5.2) months after discharge. During follow-up,there were 5 patients with mild MI and 17 patients with none or trivial MI. Seventeen patients were in NYHA class Ⅰ,5 patients were in NYHA class Ⅱ,and their heart function was significantly improved than preoperative heart function. Conclusion Artificial chordal replacement with loop technique is easy to perform with satisfactory short-to mid-term results for the treatment of MI due to mitral valve prolapse.

Citation： CAOXiang-rong, ZHANGJian-qun, LIJi-yong, ZHANGFu-en, SUNGuang-long. Short-to Mid-term Results of Artificial Chordal Loops for the Treatment of Mitral Insufficiency Due to Mitral Valve Prolapse. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 184-188. doi: 10.7507/1007-4848.20140055 Copy

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