The upside-down technique. A novel method to correct posterior leaflet prolapse.
The upside-down technique is a method for 'in situ' secondary cordae transposition for posterior leaflet lesions. The segmental prolapse of the posterior leaflet is corrected by rotating the resected segment upside-down and reattaching it to the annulus and adjacent leaflet segments. As the procedure is completed, the original annular attachment becomes the new free edge. The secondary chords, originally positioned at the base of the segment, become primary chordae. It is indicated in all cases when quadrangular resection is not feasible such as in case of calcified annulus, posterior leaflet hypoplasia, or when the prolapsing portion is wide.
Maisano
Francesco
F
Cardiac Surgery Unit, San Raffaele University Hospital, 20132 Milan, Italy. francesco.maisano@hsr.it
Alfieri
Ottavio
O