title: Chordal cutting technique through aortotomy to treat chronic ischemic mitral regurgitation: surgical technique.
abstract: 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.
authors.affiliation: Pôle de Chirurgie Cardiovasculaire, CHRU de Lille, France. g-fayad@chru-lille.fr
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.forename: Richard
authors.initials: R
authors.lastname: Azzaoui
authors.forename: Benoît
authors.initials: B
authors.lastname: Larrue
authors.forename: Antoine
authors.initials: A
authors.lastname: Cracco
authors.forename: Erwan
authors.initials: E
authors.lastname: Pansard
authors.forename: Christophe
authors.initials: C
authors.lastname: Decoene
authors.forename: Henri
authors.initials: H
authors.lastname: Warembourg
mesh_terms: 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*