Chordal cutting technique through aortotomy to treat chronic ischemic mitral regurgitation: surgical technique.
OBJECTIVE
To describe original surgical treatment in patients with ischemic mitral valve regurgitation due to tenting phenomenon.


BACKGROUND
The optimal surgical treatment of ischemic mitral regurgitation (MR) in patients with coronary artery disease is controversial. The standard treatment is revascularization and reduction annuloplasty. We describe the first clinical application of an original technique to treat MR, through aortotomy. The chordal cutting technique was described first in experimental studies by Messas et al.


METHODS
The procedure consisted in cutting the 2 strut chordae of the anterior mitral valve through a small aortotomy, using a brief conventional cardiopulmonary bypass. All the cases were controlled at the end of the procedure by transesophageal echocardiography (TEE).


RESULTS
Five patients were treated using this technique; the procedure was brief, effective and safe in all the patients. TEE showed no mitral regurgitation. No preoperative morbidity or mortality occurred and post-operative course was uneventful.


CONCLUSIONS
Chordal cutting technique through aortotomy is a safe and effective technique that should be considered to treat severe ischemic mitral regurgitation due to tenting phenomenon.
Fayad
Georges
G
Pôle de Chirurgie Cardiovasculaire, CHRU de Lille, France. g-fayad@chru-lille.fr
Modine
Thomas
T
Azzaoui
Richard
R
Larrue
Benoît
B
Cracco
Antoine
A
Pansard
Erwan
E
Decoene
Christophe
C
Warembourg
Henri
H
D001011:Aorta / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002815:Chordae Tendineae / Q000601:surgery*; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000150:complications; D017548:Echocardiography, Transesophageal; D006801:Humans; D008943:Mitral Valve / Q000033:anatomy & histology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*