title: Butterfly resection is safe and avoids systolic anterior motion in posterior leaflet prolapse repair.
abstract: BACKGROUND
  Quadrangular resection is a standard repair technique for prolapsing posterior leaflet; however, systolic anterior motion (SAM) sometimes occurs. Butterfly resection combines a triangular resection from the prolapsing edge and a reverse triangular resection to the annulus to remove redundancy, reduce leaflet height without annular plication, and minimize SAM. We assessed short-term and midterm outcomes and mitral leaflet configuration after repair vs quadrangular resection.
  
  
  METHODS
  Between 2002 and 2009, 53 patients underwent posterior leaflet resection with mitral annuloplasty, including quadrangular resection in 24 and butterfly resection in 29.
  
  
  RESULTS
  The butterfly group had a significantly larger mean ring size (29.0 vs 27.8 mm, p = 0.04). SAM occurred in 2 patients in the quadrangular group and in none in the butterfly group. SAM completely resolved in 1 patient after inotropes were weaned, but the other needed a mitral valve replacement. Predischarge echocardiography showed the butterfly group had a significantly larger anterior leaflet/posterior leaflet ratio (3.05 vs 1.53, p < 0.01) and greater length from the coaptation point to the septum (2.91 vs 2.50 cm, p = 0.02) than the quadrangular group. Measurements at 3 months showed that the differences between the two groups persisted. During follow-up, no patients died or needed reoperation for recurrence. Moderate mitral regurgitation occurred in 1 in the quadrangular group.
  
  
  CONCLUSIONS
  Butterfly resection can be safely performed without SAM and is durable in midterm follow-up. By echocardiography, this technique reduces the height of the posterior leaflet and shifts the coaptation point further away from the septum.
authors: Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Japan. toruasai@belle.shiga-med.ac.jp
authors: Tohru
authors: T
authors: Asai
authors: Takeshi
authors: T
authors: Kinoshita
authors: Soh
authors: S
authors: Hosoba
authors: Noriyuki
authors: N
authors: Takashima
authors: Atsushi
authors: A
authors: Kambara
authors: Tomoaki
authors: T
authors: Suzuki
authors: Keiji
authors: K
authors: Matsubayashi
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000503:physiopathology / Q000601:surgery*; D013599:Systole