title: Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene sutures.
abstract: BACKGROUND
  This study was a long-term Doppler echocardiographic assessment of mitral valve repair for anterior mitral leaflet prolapse using expanded polytetrafluoroethylene sutures.
  
  
  METHODS
  Between April 1992 and December 2003, we performed mitral valve repair using expanded polytetrafluoroethylene sutures in 204 patients (mean age, 54.6 years) with severe mitral regurgitation (MR) having anterior mitral leaflet prolapse. The cause of valve disease was degenerative in 181 patients (88.7%). Postoperative serial transthoracic echocardiographic studies were performed in all hospital survivors. Residual MR flow detected by color Doppler echocardiography was classified according to the maximum regurgitant jet area.
  
  
  RESULTS
  The 30-day mortality of 204 patients was 1.4% (3 deaths). There were 12 late deaths and 14 reoperations in this series. Kaplan-Meier survival and freedom from reoperation at 12 years were 84.6% +/- 4.0% and 89.9% +/- 2.9%, respectively. Postoperative transthoracic echocardiographic assessment after discharge (mean follow-up, 4.2 +/- 3.0 years) showed less than mild regurgitation (maximum regurgitant jet area < 4.0 cm2) in 80.9% of the patients. Overall, freedom from severe MR (maximum regurgitant jet area > or = 7.0 cm2) estimates at 12 years were 88.1% +/- 3.1%. Freedom from severe MR at 12 years for 114 patients with no MR (maximum regurgitant jet area = 0 cm2) on intraoperative transesophageal echocardiography and 77 patients with MR was 95.3% +/- 2.1% and 82.9% +/- 5.1%, respectively (p = 0.033).
  
  
  CONCLUSIONS
  Twelve-year echocardiographic follow-up demonstrates good long-term results of chordal replacement with expanded polytetrafluoroethylene sutures for anterior mitral leaflet prolapse. To avoid recurrence of regurgitation, a significantly high level of competence of the valve is essential in the repair of anterior mitral leaflet prolapse.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. zbn25716@nifty.com
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kasegawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Ikuko
authors.initials: I
authors.lastname: Shibazaki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Koyanagi
authors.forename: Takao
authors.initials: T
authors.lastname: Ida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002815:Chordae Tendineae / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D011138:Polytetrafluoroethylene; D012008:Recurrence; D012086:Reoperation; D013537:Sutures
chemical_list: D011138:Polytetrafluoroethylene