title: Correction of anterior mitral prolapse: the parachute technique.
abstract: OBJECTIVE
  To evaluate a new surgical technique for the correction of anterior mitral leaflet prolapse.
  
  
  METHODS
  From October 2006 to November 2011, 44 consecutive patients (28 males, mean age 55 ± 13 years) underwent mitral valve repair because of anterior mitral leaflet prolapse. Echocardiography was performed to evaluate the distance from the tip of each papillary muscle to the annular plane. A specially designed caliper was used to manufacture a parachute-like device, by looping a 4-0 polytetrafluoroethylene suture between a Dacron strip and Teflon felt pledget, according to the preoperative echocardiographic measurements. This parachute was then used to resuspend the anterior mitral leaflet to the corresponding papillary muscle. Of the 44 patients, 35 (80%) required concomitant posterior leaflet repair. Additional procedures were required in 16 patients (36%). The preoperative logistic European System for Cardiac Operative Risk Evaluation was 4.3 ± 6.9.
  
  
  RESULTS
  The clinical and echocardiographic follow-up were complete. The total follow-up was 1031 patient-months and averaged 23.4 ± 17.2 months per patient. The overall mortality rate was 4.5% (n = 2). Also, 2 patients (4.5%) with recurrent mitral regurgitation required mitral valve replacement, 1 on the first postoperative day and 1 after 13 months. In the latter patient, histologic analysis showed complete endothelialization of the Dacron strip. At follow-up, all non-reoperated survivors (n = 40) were in New York Heart Association class I, with no regurgitation in 40 patients (93%) and grade 2+ mitral regurgitation in 3 (7%).
  
  
  CONCLUSIONS
  This technique offers a simple and reproducible solution for correction of anterior leaflet prolapse. Echocardiography can reliably evaluate the length of the chordae. However, the long-term results must be evaluated and compared with other surgical strategies.
authors.affiliation: Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France. konstantinos.zannis@imm.fr
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zannis
authors.forename: Laurens
authors.initials: L
authors.lastname: Mitchell-Heggs
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Nitto
authors.forename: Matthias E W
authors.initials: ME
authors.lastname: Kirsch
authors.forename: Milena
authors.initials: M
authors.lastname: Noghin
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ghorayeb
authors.forename: Arrigo
authors.initials: A
authors.lastname: Lessana
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D010297:Paris; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome