Objective To summarize surgical techniques，advantages and clinical outcomes of mitral valvuloplasty for anterior mitral leaflet prolapse with looped artificial chordae. Methods Clinical data of 13 patients with anteriormitral leaflet prolapse and severe mitral regurgitation （MR） who underwent mitral valvuloplasty with looped artificial chordaefrom January 2009 to December 2011 in Beijing Anzhen Hospital were retrospectively analyzed. There were 8 male and 5 female patients with their age of 21-61 （39.5±12.9） years. There were 10 patients with anterior mitral leaflet chordal rupture and 3 patients with anterior mitral leaflet elongation. Preoperative left ventricular end-diastolic diameter （LVEDD） was 52-65 （58.3±1.7） mm，and left ventricular ejection fraction （LVEF） was 53%-65% （58.8%±2.8%）. All the patients underwent mitral valvuloplasty. We measured the neighboring normal chordae with a caliper for reference and constructed the artificial chordal loops on the caliper with expended polytetrafluoroethylene（ePTFE） CV4 Gore-Tex suture lines. Three to five loops were made and fixed to the papillary muscle with a Gore-Tex suture line and the free edge of the prolapsedanterior mitral leaflet with another Gore-Tex suture line，with the intervals between the loops of 5 mm. Left ventricular watertesting was performed to evaluate MR status，annuloplasty ring implantation or “edge to edge” technique was used if nece-ssary，and left ventricular water testing was performed again to confirm satisfactory closure of the mitral valve. Patientsreceived re-warming on cardiopulmonary bypass and the heart incision was closed. The effect of mitral annuloplasty was alsoassessed by transesophageal echocardiography （TEE） after heart rebeating. Warfarin anticoagulation was routinely used for 3 months after discharge. Results There was no perioperative death in this group. Twelve patients received satisfactory outcomes after 1-stage mitral valvuloplasty with looped artificial chordae and annuloplasty ring implantation. One patient didn’t receive satisfactory outcomes in the left ventricular water testing after mitral valvuloplasty with looped artificial chordae，but satisfactory outcome was achieve after “edge to edge” technique was used，and annuloplasty ring was not used for this patient. Postoperative echocardiography showed trivial to mild MR in all the patients，their LVEDD was significantly reducedthan preoperative LVEDD （47.5±2.1 mm vs. 58.3±1.7 mm，P＜0.05），and there was no statistical difference between postoperative and preoperative LVEF（58.5%±2.6% vs. 58.8%±2.8%，P＞0.05）. All the patients were followed up for 3-36 （19.5±3.7） months. Echocardiography showed mild MR in 4 patients and none or trivial MR in 9 patients during follow-up.Conclusion Mitral valvuloplasty with looped artificial chordae is an effective surgical technique for the treatment of anterior mitral leaflet prolapse with satisfactory clinical outcomes，and this technique is also easy to perform.
Objective To summarize the clinical experiences of the application of posterior leaflet chordal transfer in the treatment of anterior mitral leaflet prolapse, and to investigate the best time for mitral valve repair. Methods From October 2004 to October 2008, 16 patients with anterior mitral leaflet prolapse underwent mitral valve repair. The echocardiography diagnosis revealed that 10 patients had chordal rupture, 4 had chordal elongation, 2 had both rupture and elongation. And there were 3 with A1 segment prolapse, 6 with A2 segment prolapse, 3 with A3 segment prolapse, 2 with both A1 and A2 segment prolapse, 2 with both A2 and A3 segment prolapse. All the patients underwent posterior leaflet chordal transfer, and one of them with coronary artery disease underwent coronary artery bypass grafting. Results There was no operative death. The echocardiography examination revealed that there were 2 patients with mild regurgitation, 6 with trivial regurgitation and 8 with no regurgitation before discharge. The patients received nticoagulation treatment of warfarin for 3 months after discharge. All the patients were followed up for 1-46 months(22.0±3.5 months). The echocardiography examination showed that there were 3 patients with mild regurgitation, 7 with trivial regurgitation and 6 with no regurgitation. There were 12 patients with New York Heart Association(NYHA) classⅠ, and 4 with class Ⅱ. The left ventricular ejection fraction(LVEF) was lower than that before operation(53.0%±3.4％ vs.65.0%±4.2％,P=0.013),and there was no statistical significance compared with that before operation(61.0%±2.1％vs.65.0%±4.2％, P=0.110). The left ventricular end diastolic diameter decreased significantly compared with that before operation(50.0±3.2 mm, 47.0%±2.8 mm vs.580±6.5 mm，P=0.031，0020). The postoperative cardiac function improved significantly (P=0.002). Conclusion Posterior leaflet chordal transfer is an effective method for anterior mitral leaflet prolapse. The best time for mitral valve repair is when LVEF＞60%, left ventricle enlarges a little, and NYHA class＞Ⅲ before operation.