[Mitral valve repair by transfer of the posterior tricuspid leaflet and its chordae].
Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the mitral valve. This new technique considers the tricuspid valve as the patients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a "donor" valve, based on the knowledge that the right atrio-ventricular valve can be efficiently repaired with a very low risk of significant dysfunction. The mitral repair consists of incorporating the tricuspid autograft by securing the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplasty ring reinforces the repair. The tricuspid valve is subsequently repaired by annular plication and leaflet suture. A tricuspid ring is necessary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and degenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitral insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control transesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inserted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairment. With a 3 to 7 month follow-up, the results are stable.
Hvass
U
U
Service de chirurgie cardiaque, hôpital Bichat, Paris.
Chatel
D
D
Assayag
P
P
Juliard
J M
JM
Laperche
T
T
Caliani
J
J
Oroudji
M
M
Pansard
Y
Y
D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000637:transplantation*; D004452:Echocardiography; D004696:Endocarditis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000637:transplantation*
Réparations mitrales par transfert du feuillet postérieur de la valve tricuspide avec ses cordages.