title: "Bow-tie" mitral valve repair: an adjuvant technique for ischemic mitral regurgitation.
abstract: BACKGROUND
  Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation.
  
  
  METHODS
  We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths.
  
  
  RESULTS
  Mitral regurgitation decreased from 3.6+/-0.5 to 0.8+/-0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33%+/-13% to 45%+/-11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5+/-0.3 to 2.1+/-0.3 cm2, with a mean transvalvular gradient of 4.5+/-2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function.
  
  
  CONCLUSIONS
  These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Umaña
authors.forename: B
authors.initials: B
authors.lastname: Salehizadeh
authors.forename: J J
authors.initials: JJ
authors.lastname: DeRose
authors.forename: T
authors.initials: T
authors.lastname: Nahar
authors.forename: A
authors.initials: A
authors.lastname: Lotvin
authors.forename: S
authors.initials: S
authors.lastname: Homma
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D005260:Female; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications