title: Surgical application for a prolapse of the anterior mitral leaflet by replacing artificial chordae with polytetrafluoroethylene grafts.
abstract: OBJECTIVE
  There are an increasing number of reports concerning mitral valve repair by a reconstruction of the chordae tendinae using expanded polytetrafluoro-ethylene (PTFE) sutures. However, little information is available about extended application or results of this technique for an extended prolapse of the anterior mitral leaflets.
  
  
  METHODS
  Between July 1991 and August 2003, 28 patients with moderate to severe mitral regurgitation as a result of a prolapse of anterior leaflets (age range, 15-73 years) underwent mitral valve repair by reconstruction of the artificial chordae with 4-CV expanded polytetrafluoroethylene sutures without a leaflet resection. Either Kay's suture technique or ring annuloplasty was also performed to correct annular dilatation in all patients.
  
  
  RESULTS
  No operative death or late mortality was observed. The prolapsed segment, which was successfully repaired, was within 33% of the anterior mitral leaflet (AML) in 6 patients, from 33% to 50% in 5, from 50% to 99% in 11, and 100% in 6 patients. Before discharge, immediate postoperative echocardiography showed less than moderate mitral regurgitation in 28 of 28 patients. The follow-up, consisting of a clinical examination and serial echocardiograms, was complete in all cases and the mean follow-up period was 80.6 months (range, 12-146). There were two failures that required a reoperation because of a worsening mitral regurgitation and hemolytic anemia (elongation of anchored side of papillary muscle). The other two patients required mitral valve replacement due to a progressive regression of the left ventricular function, although the regurgitation worsened from a mild level to a moderate one. When the reoperated patients were excluded from the following data, the degree of mitral regurgitation, estimated by echocardiography performed at recent follow-up period, was none in 10 patients, trivial in 13 patients, and mild in 1 patient. In addition, the systolic and diastolic dimensions of the left ventricle decreased significantly (P < 0.01).
  
  
  CONCLUSIONS
  The replacement of artificial chordae was not complicated and it seemed to help to preserve a good relationship among leaflet tissues, chordae, and papillary muscles. We therefore suggest that the extensive use of PTFE artificial chordae appears to be a promising procedure for the repair of all kinds of mitral lesions causing mitral regurgitation.
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tomita
authors.forename: Hisataka
authors.initials: H
authors.lastname: Yasui
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iwai
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nishida
authors.forename: Hideki
authors.initials: H
authors.lastname: Tatewaki
authors.forename: Shigeki
authors.initials: S
authors.lastname: Morita
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutsune
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nishimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D002815:Chordae Tendineae / Q000601:surgery*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000494:pharmacology; D011336:Probability; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene