Annular compression stitch for quadrangular resections in mitral valve repair.
OBJECTIVE
Quadrangular resections for posterior mitral leaflet prolapse create a defect that requires readaptation of the annulus as well as the leaflet cut edges. A variety of techniques has been described to narrow the posterior mitral annulus. Herein is described a simple compression stitch that allows compensation of annular size reduction even for large resections of the mural leaflet.


METHODS
The annular compression stitch consists of four bites: the first stitch is placed from the atrium into the ventricle; the second takes a piece of ventricular myocardium parallel to the mitral ring; the third returns the needle into the atrium some millimeters outside the opposite cut edge of the mitral leaflet; and the fourth stitch grabs atrial myocardium parallel to the previous ventricular stitch. Tying the knots compresses the annulus to an extent that allows reanastomosis of the two leaflet cut edges.


RESULTS
This new technique was used in 212 patients undergoing mitral valve repair. Intraoperative outcome was excellent, and after a mean follow up period of 2.5 years no reoperation was needed due to failure of the annular compression stitch.


CONCLUSIONS
The new compression stitch simplifies the repair, avoids the creation of a trench, and allows readaptation of the two mural leaflet edges without tension, even in large posterior resections.
Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt am Main, Germany.
Omer
O
Dzemali
Peter
P
Kleine
Anton
A
Moritz
D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012720:Severity of Illness Index; D013536:Suture Techniques; D016896:Treatment Outcome