title: Transposition of chordae in mitral valve repair. Mid-term results.
abstract: BACKGROUND
  Prolapse of the anterior mitral leaflet, unlike a posterior prolapse, is a difficult lesion to repair. Leaflet plication and triangular resection are satisfactory techniques only in case of a limited prolapse. Chordal replacement has also been proposed but uses foreign material. The purpose of this report is to assess the results of transposition of chordae for the correction of mitral regurgitation (MR) caused by anterior leaflet prolapse.
  
  
  RESULTS
  Between January 1986 and December 1990, 44 adult patients with MR caused by anterior leaflet prolapse underwent repair with transposition of chordae as one of the techniques. This population was retrospectively studied to assess the early and late results of this procedure. Chordae were transferred from the posterior to the anterior leaflet (n = 25) or from an intermediary to a free edge position on the anterior leaflet (n = 21) (two patients underwent both procedures). Two patients died (4.5%). None required early reoperation. Follow-up was complete and ranged from 18 to 82 months (mean, 40.2 +/- 19 months). No patient died during follow-up. Two patients were reoperated on 6 and 8 months after surgery for recurrent MR unrelated to chordal transfer disruption. Doppler echocardiographic studies were available in 95% of the cases at latest follow-up and showed no or minimal MR (0 to 1/4) in 87.5% of the patients and mild MR (2/4) in 12.5%.
  
  
  CONCLUSIONS
  Transposition of chordae appeared to be a simple and safe procedure for correction of anterior mitral prolapse. Transposition of chordae allowed extension of the indications of valve repair. A longer follow-up will be necessary to draw firm conclusions, but mid-term results are encouraging.
authors.affiliation: Department of Cardiovascular Surgery, Hôpital Broussais, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Sousa Uva
authors.forename: P
authors.initials: P
authors.lastname: Grare
authors.forename: V
authors.initials: V
authors.lastname: Jebara
authors.forename: J F
authors.initials: JF
authors.lastname: Fuzelier
authors.forename: M
authors.initials: M
authors.lastname: Portoghese
authors.forename: C
authors.initials: C
authors.lastname: Acar
authors.forename: J
authors.initials: J
authors.lastname: Relland
authors.forename: S
authors.initials: S
authors.lastname: Mihaileanu
authors.forename: J N
authors.initials: JN
authors.lastname: Fabiani
authors.forename: A
authors.initials: A
authors.lastname: Carpentier
mesh_terms: D002815:Chordae Tendineae / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors