Chordal cutting VIA aortotomy in ischemic mitral regurgitation: surgical and echocardiographic study.
BACKGROUND
Chordal cutting through atriotomy has been proposed to treat significant resting ischemic mitral regurgitation (MR) due to anterior leaflet tenting. In addition, MR may exacerbate during exercise not only trough exercise-induced ischemia but also through an increase in tenting area. Accordingly, we aimed to perform chordal cutting through aortotomy in patients with exercise-induced ischemic worsening of MR.


METHODS
Five patients with ischemic MR, due to anterior leaflet tenting, which worsened during exercise echocardiography were enrolled. All patients underwent cutting of the 2 basal chordae attached to the anterior mitral leaflet associated with myocardial revascularization. Three patients had additional mitral valve annuloplasty. Postoperative MR was evaluated using exercise echocardiography.


RESULTS
Age ranged from 63 to 78 years and 4 patients were male. Preoperative LV ejection fraction averaged 39 +/- 3%. Chordal cutting was performed through aortotomy allowing comfortable access to the anterior mitral valve. Mitral effective regurgitant orifice at rest and at peak exercise was reduced by surgery (10 +/- 3 to 0.6 +/- 0.5 mm(2) at rest and from 20 +/- 3 to 6 +/- 2 mm(2) at peak exercise; p = 0.03). Mitral tenting area at rest and at peak exercise was concomitantly reduced by surgery (1.83 +/- 0.21 cm(2) to 0.50 +/- 0.4 cm(2) at rest and from 3.11 +/- 0.58 to 1.7 +/- 0.5 cm(2) at peak exercise; p = 0.03). Left ventricular size and function remained unchanged after surgery.


CONCLUSIONS
Chordal cutting through aortotomy may be an effective option to treat ischemic MR due to anterior leaflet tenting. Associated with myocardial revascularization, it resulted in a decrease of MR at rest and during exercise through a decrease in tenting area without impairment of LV function.
Fayad
Georges
G
Cardiovascular Surgery Department, University Hospital, Lille, France. g-fayad@chru-lille.fr
Maréchaux
Sylvestre
S
Modine
Thomas
T
Azzaoui
Richard
R
Larrue
Benoît
B
Ennezat
Pierre-Vladimir
PV
Bekhti
Hakim
H
Decoene
Christophe
C
Deklunder
Ghislaine
G
Le Tourneau
Thierry
T
Warembourg
Henri
H
D000368:Aged; D001011:Aorta / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002815:Chordae Tendineae / Q000601:surgery*; D004452:Echocardiography; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D017202:Myocardial Ischemia / Q000209:etiology / Q000601:surgery; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome