title: Safety and durability of mitral valve repair for anterior leaflet perforation.
abstract: OBJECTIVE
  We sought to evaluate mitral valve repair for anterior leaflet perforation.
  
  
  METHODS
  Between October 1987 and October 2006, 26 patients with mitral valve anterior leaflet perforation underwent mitral valve repair (median age, 54 years; 18 [69%] were male).
  
  
  RESULTS
  The indication for operation was severe mitral regurgitation only in 14 patients, both aortic regurgitation and mitral regurgitation in 11, and ventricular septal defect repair in 1. Twenty-four (92%) patients had endocarditis and 13 (50%) had at least mild aortic regurgitation preoperatively. Left atriotomy was performed in 17 (65%) and aortotomy in 8 (31%). Six (23%) patients had visible vegetations at the time of repair. For anterior leaflet repair, a patch was used in 11 (42%) patients and primary suture closure in 15 (58%). Eighteen patients underwent concomitant cardiac surgical procedures. Postoperative follow-up (mean, 6 years) was available for 25 (96%) patients. There was 1 early death from multiorgan failure and 2 late deaths. Patient survival was 95% at 1 year and 90% at 5 years. Left ventricular end-diastolic dimension improved significantly after mitral valve repair at dismissal (n = 16; -9.4 mm; P < .01) and during follow-up (n = 11; -10.8 mm; P < .01). Only 1 (4%) patient had mitral valve reoperation after 7 years owing to recurrent endocarditis 6 months after repair.
  
  
  CONCLUSIONS
  Mitral valve anterior leaflet perforation may be safely repaired with good midterm survival and durability.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Basar
authors.initials: B
authors.lastname: Sareyyupoglu
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012449:Safety; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult