title: Resecting and nonresecting techniques for posterior mitral leaflet prolapse.
abstract: BACKGROUND
  Posterior leaflet (PL) prolapse is commonly treated with quadrangular resection, but nonresecting techniques were proposed as an alternative. We evaluated our experience to identify specific indications to nonresecting techniques.
  
  
  METHODS
  From March 2006 to February 2009, 60 patients were treated for PL prolapse, 21 using resecting (group R), and 39 nonresecting (group NR) techniques. Patients in group R had fibroelastic deficiency with isolated P2 prolapse and P1 or P3 (or both) thin or short (n = 15); need of excessive P2 resection (more than 1/3 of the posterior annulus) (n = 10); dominant or codominant circumflex artery (n = 10). Some of them were young and were operated on without preoperative coronary angiography (n = 4).
  
  
  RESULTS
  One patient (1.7%) in group R died during the first 30 days after surgery. Three-year survival was 89.6 ± 4.5, similar in both groups. A postoperative echocardiogram was obtained 20 ± 6 months after surgery in every survivor. Mitral regurgitation decreased significantly soon after surgery without any significant modification at follow-up in both groups.
  
  
  CONCLUSIONS
  nonresecting techniques provide good midterm results, similar to resecting ones. To resect or not resect part of the PL has, in our personal practice, its own indications and contraindications. Extensive use of artificial chords and reduction of PL height, when indicated, is able to provide other tools to safely expand mitral repair for PL prolapse.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. calafiore@unich.it
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.forename: Angela Lorena
authors.initials: AL
authors.lastname: Iacò
authors.forename: Egidio
authors.initials: E
authors.lastname: Varone
authors.forename: Antonella
authors.initials: A
authors.lastname: Romeo
authors.forename: Sara
authors.initials: S
authors.lastname: Mangiafico
authors.forename: Rocco
authors.initials: R
authors.lastname: Meduri
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome